Foster Family Inquiry Form

Thank you for your interest in Nightlight's Healing Homes Foster Care Program! Please fill out this inquiry form, which will help us answer your questions. Once complete, we will contact you within two business days. We're looking forward to talking with you soon! 

Prospective Foster Father Father First Name Father Last Name Father DOB Father Cell Phone ()-ext Enter Int'l Number Father Email Interests Gender Preference Male Female   Child Preference Min Age Child Preference Max Age Number of children desired Any other comments regarding child(ren) desired What is your primary motivation for pursuing foster care? Do you have any prior experience mentoring or parenting children with trauma backgrounds? YesNo If yes, explain: I am willing to provide traditional foster care for children where the case plan is reunification or another non-adoptive outcome? YesNo I am only interested in adopting out of foster care. YesNo Referral Info How did you hear about Nightlight?* A Fearless Life Foundation Adoption Bridge adoption.state.gov Adoptive Family (Please specify below) Agency (Please specify below) Attorney (Please specify below) Church (Please specify below) Client Referral (Please specify below) Clinic (Please specify below) Conference (Please specify below) Country's Central Authority Creating a Family Embryo Adoption Awareness Center Family Member Focus on the Family Friend (Please specify below) Home Study Provider (Please specify below) Host Family (Please specify below) IAAME Internet Search (Please enter search terms used below) Magazine (Please specify below) Medical Professional (doctor, nurse, midwife, etc.) National Down Syndrome Adoption Network National Embryo Donation Center News Site Online Group (Please specify below) Other (Please specify below) Pregnancy Resource Center (Please specify below) Radio Spot Returning Client Social Media (Please specify below) Storage Facility Support Group Television Waiting Children Constant Contact YouTube   Please provide the name of the specific persons or places

Prospective Foster Mother Mother First Name Mother Last Name Mother DOB Mother Cell Phone ()-ext Enter Int'l Number Mother Email Preferred Contact Method Home Phone Family Home Email Mother Email Father Email Father Work Email Mother Cell Phone Mother Work Email Father Cell Phone Mother Work Phone Father Work Phone   Family Address Street Address City State/Region AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code County Preliminary Questions The questions below are topics that will be addressed in a home study in order to certify you as a foster parent. Each state will have unique qualifications around who can and cannot provide foster care services. Your answers to these questions help us provide an honest assessment about steps that may need to be taken for certification. Have you ever begun a home study that was never completed? YesNo Have you ever been denied a home study? YesNo If yes, please explain. If married, the date of legal marriage: Have you ever received treatment or taking medication for a mental condition? If so, please provide more details: Have you ever been arrested? YesNo Have you ever been treated for drug or alcohol abuse? YesNo Are you currently or have you ever been a certified foster parent? YesNo If yes, please explain.

I/We affirm that by submitting this Inquiry Form that the information provided is true and accurate. I/We further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime.

By clicking the Save/Submit button below you agree to InReach Solutions' Terms of Service and Privacy Policy

Submitting...

Deuteronomy 10:18, “He defends the cause of the fatherless and the widow, and loves the foreigner residing among you, giving them food and clothing.”