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Home » Get Involved » Become a Foster Parent » Foster Care Pre-Qualification Form

Foster Care Pre-Qualification Form

If you are 21 or older and have enough room in your heart and home, fill out our online pre-qualification form.

First Name:*
Last Name:*
Age:
Co-Applicant First Name:
Co-Applicant Last Name:
Co-Applicant Age:
Address
Street AddressAddress Line 2CityStateZIP Code
Work Phone:
Home Phone:*
Email*
1. How many ADULTS live in your household?
How many CHILDREN live in your household?
What are their ages and gender?
2. How many bedrooms do you have in your home?
- One
- Two
- Three
- Four
- Five
- Six
3. A foster child must have their own bed/crib, in a room with at least 45 square feet with a window. Do you have such accommodations?
- Yes
- No
4. Are you interested in
- Foster Care
- Adoption
- Both
5. What type of child would you like to foster/adopt?
Age:
Sex:
- Male
- Female
No. of Children:
6. Would you like children with special needs (Medical, Behavorial, Educational, Psychiatric)?
- Yes
- No
7. Appointments for children can be as often as weekly. These include family visiting, medical or therapy appointments. Are you able to transport to and from these appointments?
- Yes
- No
8. Monthly Income
Work Hours
Occupation
9. Appointments and training classes can be in the daytime or evenings. Which one would you prefer?
- Day
- Evening
10. Have you ever been with another Foster Care agency?
- Yes
- No
If yes, name of agency:
What year?

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