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Application for Foster ParentingNote: This is offered here as a guideline only. It is not an actual application.
The Foster Care Agency is required to assess a potential foster home according to state regulations (3700.64). Any information you can provide us in these area will help us in making our assessment. The FFCA (Foster Family Care Agency) regulations are as follows: (A) The FFCA shall consider the following when assessing the ability of applicants for approval as foster parents:
(B) In making a determination in relation to subsection (a) the FFCA shall consider:
Agency staff will utilize at a minimum the application, references, criminal background checks, childline background checks, physical exams, foster home inspection report, and interview to make our determination. Our agency's foster homes must be available to children of any race or color. If you have any problems accepting a child of another color into your home, please do not apply to this agency as foster parents. NOTE: This is offered here as a guideline only. It is not an actual application, but will give you an idea of the questions asked during your initial application process. If you are interested in pursuing fostering and would like someone in your state to contact you, please fill out our contact form. Wife's Full Name: _____________________________________ Husband's Full Name: __________________________________ Telephone Number: (home) ____________________ (work)_____________________ Home Address: How long did family reside here?________________ List all persons living in your home, along with age, relationship to parents, and occupation: (Name, Age, Relationship, and Occupation): List the reasons why you want to be foster parents: Describe how you feel foster parenting will affect yourselves and your own children. Include what you think will be the positive and negative aspects of foster parenting. Include your biological children's attitudes toward accepting a client into your home. Describe the attitudes of any significant extended family members toward you becoming foster parents. Describe your personalities and attitudes toward children: Describe your attitudes and practices toward child discipline and corporal punishment (spanking, slapping mouths, etc.); How do you discipline you own children: Describe any prior experience youhave in caring for, supervising, or teaching children: How do you feel about a child of another religion and/or culture being placed in your home? Describe any prior experience in working with children with special needs, such as physical handicaps and emotional disturbances: Do you wish to work with children with special needs as described above? Descibe your perceived ability to accept and respect a child as he is: Describe your perceived ability to accept a foster child's parents and work with them toward the return of your foster children to their natural homes: Describe your perceived ability to work with the Agency in planning and managing your foster child/children's care. How many foster children do you feel could successfully live with your family? What age group of foster children would you prefer? Do you prefer boys, girls, or have no preference? Describe your ability to care for the needs of a client as well as of your biological children: Describe your ability to meet the changing needs of a client over the course of a placement. Describe your perceived ability to provide continuity of care throughout a client's placement. Describe the characteristics of children who would be best suited to your family: Describe your home surroundings, and neighborhood in which you live. On a separate sheet of paper, draw a layout of your home including the square footage of bedrooms. Draw existing beds in the bedrooms. Write in who sleeps in which bedrooms and where a foster child/children would sleep. Describe any safety hazards in or around your home: List any pets that live inside and outside your home (in case of allergies): Describe any cigarette, cigar, or pipe smoking in your home (in case of allergies): Describe any use of alcohol in your home. Has the use of alcohol ever created a problem for any member of your family. Include any charges or traffic violations while under the influence of alcohol. (This information is needed for placement of children with substance abuse problems): Describe any use of drugs in your home. Has any family member ever used illegal drugs or abused prescription drugs? Describe what toys, recreational equipment, and facilities are available in or near your home: Describe the quality of your housekeeping and sanitation: ___________________________________________________ ___________________________________________________ ___________________________________________________ Medical care: Family Doctor:_______________________________ Address:____________________________________ Family Dentist:_______________________________ Hospital used for emergency treatment: _______________________________________ Local Elementary school:_______________________ Local Middle school:___________________________ Local Junior High School:_______________________ Local High School:_____________________________ If you currently have children in school, describe your working relationship with school personnel. Family background: Attach extra sheets of paper for this information. Write a life story describing your family backgrounds including number of children, quality of family relationships, and any significant information which will help us know your family background. Describe your family life growing up and your adult life. Describe what happened in your life to lead you to the decision of applying to become foster parents. The wife and husband need to write separate stories. Education: List high school, any college, training/technical school, dates of graduation; and degrees held. Wife: ___________________________________________________ Husband: ___________________________________________________ Work Experience: List all employers, addresses, positions held, dates of employment, and reasons for leaving. Wife: ___________________________________________________ Husband: ___________________________________________________ Dependability: List five references (excluding relatives) with complete addresses and telephone numbers: 1. ___________________________________________________ 2. ___________________________________________________ 3. ___________________________________________________ 4. ___________________________________________________ 5. ___________________________________________________ If either parent ever received workman's compensation, please explain. If neither did, please write "None" If any family members have any physical or mental health problems which could interfere with their ability to care for a child/adult in your home, please explain. Please include all psychiatric hospitalizations and treatment including medications for mental disorders. If there are no such problems, please write "None" Marital History: List marital history for both parents including dates of marriages, separations, divorces, deaths, and names of spouses. It is important to have a stable marriage with no separations for at least two years to be approved for foster parenting (exception if married less than two years). Family stability: Describe your relationship with your own children, level of happiness/satisfaction within the family, your expectations for your children, and your preferred methods of reward and punishment. If any family members were ever convicted of a crime, please explain. If no one was ever convicted of a crime, please write "None". Families must not depend on foster care payments to meet the basic needs for their families. Please list total annual family gross income for the last three years (begin with most current): $____________, $_____________, $_____________ Describe your relationship with your relatives, friends, and neighbors: Church and community affiliations: Religious preference: ______________________________ Describe your church affiliation: List participation in any other community activities and /or organizations for all family members: Please describe any areas where you feel that you would especially need guidance and/or support. Please list any other information that you believe would be helpful to the agency in making a determination about your ability to provide high quality foster parenting. I certify that the information provided on this application is accurate. I give the Agency permission to contact my previous employers, references, and family physician. This agency can release this information to others upon request. Wife's signature: ____________________________________ Husband's signature: _________________________________ Attach: |
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