Foster Parent Application | The Children's Aid Society

Applicant #1 Name: *

Applicant #1 Gender (select one):

Male

Female

Applicant #1 If you selected "other" for the previous question, please specify preferred gender pronoun:

Applicant #1 Address Line 1: *

Applicant #1 Address Line 2:

Applicant #1 Address City: *

Applicant #1 Address State: *

Applicant #1 Address Zip Code: *

Applicant #1 Telephone Number 1: *

Applicant #1 Telephone Number 1 Type (select one): *

Home

Work

Mobile

Applicant #1 Telephone Number 2:

Applicant #1 Telephone Number 2 Type (select one):

Home

Work

Mobile

Applicant #1 Email: *

Applicant #1 Date of Birth:

Applicant #1 Ethnicity (Cultural Identity):

Applicant #1 Religion:

Income Source Applicant #1:

Applicant #1 Primary Language:

Applicant #1 Other Languages:

Applicant #2 Name:

Applicant #2 Gender (select one):

Male

Female

Applicant #2 If you selected "other" for the previous question, please specify preferred gender pronoun:

Applicant #2 Telephone 1:

Applicant #2 Telephone 1 Type (select one):

Home

Work

Mobile

Applicant #2 Telephone 2:

Applicant #2 Telephone 2 Type (select one):

Home

Work

Mobile

Applicant #2 Email:

Applicant #2 Date of Birth:

Applicant #2 Ethnicity (Cultural Identity):

Applicant #2 Religion:

Applicant #2 Primary Language:

Applicant #2 Other Languages:

Income Source Applicant #2:

Number of Children in the Household:

Number of Male Children:

Number of Female Children:

Ages of Children:

Other Household Members (List gender and role of each additional household member):

Apartment/Home (select one):

Own

Rent

Apartment/Home Lease Holder:

Interest in Special Populations (check all that apply):

Preferred Age Range of Foster Child:

Preferred Gender of Foster Child (select one):

Male

Female

No Preference

Are you currently or have you ever been a Foster Parent with Children's Aid or another agency?:

If you answered "yes" - please provide the agency and dates:

Have you or any household member been involved with ACS (Administration for Children's Services)? (select one):

Yes

No

Have you or any household member been involved with Preventive Services? (select one) :

Yes

No

Have you or any household member been court involved? (select one):

Yes

No

If you answered "yes" to any of the three previous questions, please explain in the space below. :

Note: Answering "yes" to the previous three questions will NOT automatically disqualify you from consideration.

What is the best method or methods for Children's Aid to reach you? (check all that apply):

Home Phone

Work Phone

Mobile Phone

Email

If you would like to be contacted by phone, when are you available to discuss becoming a foster parent? (dates/times):

If you answered "other" to the last question or have any clarifications about the above answers, please explain further in the space below: