Become a Foster Parent

Personal Information

Name

Street

City

State

Zip Code

Date of Birth

Gender —Please choose an option—MaleFemale

Home Telephone Number

Work Phone Number

Cell

Email Address

Home Relationship

Are you Single or Married? —Please choose an option—SingleMarried

Are you currently living, even part time, with any romantic partner whom you are not married to? —Please choose an option—YesNo

Have you previously been divorced? —Please choose an option—YesNo

List the name, date of birth, relationship, occupation and gender of all other persons living in the home

Stability

Have you, or anyone in the home, previously been charged with or been convicted of a crime? If so, please describe the circumstances.

Have you, or has anyone in your home, been arrested? If so, please describe the circumstances.

Have you, or has anyone in your home, been the subject of a report of child abuse? If so, please describe the circumstances.

Are you financially self-sufficient, that is, do you rely solely on your own income for all necessities? —Please choose an option—YesNo

Approximate income

Frequency

Gross/Net —Please choose an option—GrossNet

Have you ever been subject to foreclosure proceedings? —Please choose an option—YesNo

Have you ever filed for bankruptcy? —Please choose an option—YesNo

Do you expect to retain your current employment for the foreseeable future? —Please choose an option—YesNo

Have you ever filed for a protection order? —Please choose an option—YesNo

Has a protection order ever been filed against you? —Please choose an option—YesNo

How long have you lived in the state?

Do you plan on moving in the near future? —Please choose an option—YesNo

Have you ever received counseling/treatment/medication for mental health or substance abuse? If so, please describe.

Foster Openness

How did you become interested in becoming a resource parent?

What made you decide to become a resource parent?

How long have you been interested in becoming a resource parent?

Have you ever cared for children through an agency before?

What agency?

How long were you with this agency?

What are the circumstances behind you leaving this agency?

Are there children you would not be willing to provide care for?

Would you accept siblings?

Are you willing to care for children that you would not be planning to adopt?

When would you like to start caring for children?

Choice of Agency

How did you find out about Catholic Social Services?

Have you contacted any other agencies about caring for children?

Why are you interested in working with Catholic Social Services?

Ethical Compliance:

Have you ever been contacted by or been in communication with any law firm or advocacy group? —Please choose an option—YesNo