SO YOU WANT TO BE THERAPEUTIC FOSTER PARENT

PROSPECTIVE FOSTER PARENT QUESTIONNAIRE

Name:              

Date:           

Address:
                   

 Phone:     

 Best time to call:      

 Email Address:         

 How did you hear about HOPE, Inc.?  

 Is your home currently or has ever been licensed to provide foster care for any other agency?   Select one Yes No

If yes, which agency?  

Have you or any person in your home ever been arrested or convicted of a felony or barrier crime?    Select one Yes No

If yes, which agency?  

Have you or any adult living in your home ever been denied a foster care license or license renewal  Select one Yes No

           if yes - please explain:  

Have you or any person living in your home ever been reported for suspected abuse or neglect?   Select one Yes No

If yes, what was the outcome?  

What experience do you have working with children other than family members:  

If you are married you and your spouse are required to attend orientation and foster parent training “see schedules”. 
Are you able to do so?   Select one Yes No

 NAMES AND AGES OF ALL OTHER MEMBERS OF THE HOME