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2. Foster Parent Orientation Form
4. Full Name of Applicant*
5. Date Orientation Completed*
   Date Orientation Completed

   Date Orientation Completed
7. Date of Birth*
   Date of Birth
9. Home Address*
10. City*
11. Zip Code*
13. Home Phone*
14. Applicant Cell Phone*
16. Co-Applicants Phone Number
17. Email Address*
21. Name of Co-Applicant
22. Date of Birth
    Date of Birth
24. Co-Applicant Cell Phone
26. Give names, relationship and birthdates of everyone, in addition to applicant/co-applicant living in your home:
30. APPLICANT
32. Are you currently employed?*

    1. Full Time
    2. Part Time
    3. No
33. Place of employment:*
35. What are your work hours?*
37. CO-APPLICANT
39. Are you currently employed?

    1. Full Time
    2. Part Time
    3. No
40. Place of employment:
42. What are your work hours?
46. Are you interested in Interim (Full-time) or Respite (Part-time; such as weekends) Care?*
48. What is the age range of children you are interested in caring for:*

    1. Open to all ages
    2. Infants
    3. Toddlers
    4. School Age
    5. Teens
    6. Young Adults 18 - 21 years old

    You may check more than one.
49. What gender of children are you willing to care for?*

    1. Male
    2. Female
    3. Either
51. How did you hear about Foster Care?*

    1. Family/Friend
    2. Social Worker
    3. Church/CKI

    1. Website
    2. Past Experience
    3. Foster Care advertisements

    1. Work in related field
    2. Poster/Brochure
    3. Other
53. Which of the following family groups do you represent?

    1. Married Couple
    2. Unmarried Couple
    3. Single Female
    4. Single Male
54. Race

    1. African American
    2. Native American
    3. East Indian
    4. Asian
    5. Caucasian
    6. Hispanic
    7. Other
56. After this form is processed by the Foster Care Unit, you will receive a call to schedule your in-home orientation meeting with a Licensing Social Worker.
58. Thank you for your interest in Foster Care!
Leave This Blank:


60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

* indicates a required field