Foster and Adoptive Information Form

*Parent Name 1:

*Date of Birth Parent 1:

*Email Address:

*Parent Name 2:

*Date of Birth Parent 2:

*Email Address:

*Contact Number
(format:xxx-xxx-xxxx):

*Address
(Place you will live in for home study & to raise the child in):

*County:

*How did you hear about us?

*Are you willing to foster children of all ages?:

*Yes/No Please Explain:

*Select your marital status:

*What is your current home type:

*What are the number of bedrooms?

*Number of rooms available for children in foster care?

Who currently sleeps in each room?

Room 1:

Room 2:

Room 3:

Room 4:

Room 5:

*What is the number of additional adults living in the home?

*Number of youth under 18 living in the home?

*Have you been licensed to foster in FL or any other state?
List the state and agency:

*List ALL members of your household
(Anyone who lives in your home not already listed):

*Do you have a vehicle that can hold your family and an extra child?
(Yes/No)

*Are you currently employed?
(Yes/No)

*Do you all produce enough Income to support your family and
an additional child if placed in your home?
(Yes/No)

*Assistance from Government such as Food Stamps, Section 8
housing or unemployment?
(If yes, please explain)

*Does anyone in the house have any arrests or felonies?(even if expunged or sealed)?
(If yes, please explain)

*Have any of your household members lived out of the State of Florida
in the past 5 years?

If yes, name the household member(s) and state(s):

*Are you each U.S. citizens? If not, what is your status?

*What’s your motivation to become a foster parent/family?