Foster Program Registration

Foster Family - Application Form

Applicant 1*
First Middle Last
Preferred Name
First Last
Please select your state*
Foster Care Interest*
- Traditional Foster Care
- Short-Term Respite Care
- Adoption from Foster Care
- Open to Any Opportunity
Traditional - Open to temporary placement of children. That could be short or long-term. Short-term Respite/Emergency placement - Open to short term, temporary placement of children in emergency situations or those in need of respite care. Adoption from Foster Care - Only open to adoptive placement of legaly free children with no interest in fostering.
Have you worked with any foster/adoption agency, home study agency and/or attorney?
- Yes
- No
If yes, please list contact information
A-1 - Have you ever been turned down by another agency?
- Yes
- No
A1 -If you have been turned down by another agency, please explain.
A1 - Maiden Name (if applicable)
A1 - Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
A1 - Primary phone contact*
A1 - May we leave a voice message?*
- Yes
- No
A1 - Email*
A1 - Place of Birth City / State / Country*
A1 - How long have you lived in your current state of residence?*
A1 - Date of birth*
MM slash DD slash YYYY
A1 - Ethnicity (Optional)
A1 - Last 4 digits of your Social Security Number*
A1 - Employer*
A1 - Occupation*
A1 - Annual Salary in US Dollars*
A1 - Other Financial Resources (optional)
Please provide other financial resources if applicable.
A1 - Have you ever filed for bankruptcy?*
- Yes
- No
A1 - Explain your bankruptcy including dates.
A1 - Are you a U.S. Citizen?*
- Yes
- No
A1 - Have you been in a prior marriage?*
- Yes
- No
A1 - Have you been separated from your spouse?*
- Yes
- No
A1 - List the gender and date of birth of any current children*
A1 - Have you ever been accused of child abuse, neglect and/or domestic violence?*
- Yes
- No
A1 - Please include instances of accusation for child abuse, neglect and or domestic violence. Include dates, city and state
A1 - Are you undergoing any medical treatments?*
- Yes
- No
A1 - Please list any medical conditions you are being treated for.*
A1 - Are you currently being, or have you previously been treated for an emotional condition?*
- Yes
- No
A1 - Please list reasons if you have undergoing or have you previously undergone for counceling
A1 - Do you have any history of substance abuse?*
- Yes
- No
A1- Explain your substance abuse.
A1 - Have you ever been arrested, have criminal records or convictions?*
- Yes
- No
A1 - If Yes, Please include a list of records, dates and include any juvenile or expunged records.
A1 - Are you currently married*
- Yes
- No
A1 - Please select your marital status*
A1 - Date of Marriage
MM slash DD slash YYYY
A2 - Applicant 2*
First Middle Last
A2 - Preferred Name
First Last
A2 - Maiden Name (if applicable)
A2 - Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
A2 - Phone*
A2 - Email*
A2 - May we leave a voice message?*
- Yes
- No
A2 - Place of Birth City / State / Country*
A2 - Date of birth*
MM slash DD slash YYYY
A2 - How long have you lived in your current state of residence?*
A2 - Ethnicity (Optional)
A2 - Last 4 digits of your Social Security Number*
A2 - Employer*
A2 - Occupation*
A2 - Annual Salary in US Dollars*
A2 - Other Financial Resources (optional)*
A2 - Have you ever filed for bankruptcy?*
- Yes
- No
A2 - Please explain the circumstances around your bankruptcy.
A2 - Is Applicant 2 a U.S. Citizen?*
- Yes
- No
A2 - Have you been in a prior marriage?*
- Yes
- No
A2 - Have you been separated from your spouse?*
- Yes
- No
A2 - List the gender and date of birth of any current children if different from above
A2 - Have you ever been accused on child abuse, neglect and/or domestic violence?*
- Yes
- No
A2 - Are you undergoing any medical treatments?*
- Yes
- No
A2 - Are you currently being, or have you previously been treated for any mental health issues*
- Yes
- No
A2 - Do you have any history of substance abuse?*
- Yes
- No
A2 - Explain your history of substance abuse.
A2 - Have you ever been arrested, have criminal records or convictions?*
- Yes
- No
A2 - Explain your criminal history.
Preferred gender for foster child/children?*
- Female
- Male
- Open to either
Are you open to sibling groups*
- Yes
- No
Number of children you would like to foster (individual or sibling group)*
Enter the age range of child/children you wish to foster.*
A2 - Agency information Applicant 2*
Please list any agency, home study agency and/or attorney contact information (if applicable).
A2 - May we contact your former agency?
- Yes
- No
A2 - Have you ever been turned down by another adoption agency?*
- Yes
- No
A2 - If you have been turned down by another agency - please explain.
Please share any special skills, interests, or specialized populations that you have interest in working with as a foster parent.*
Consent*
I agree to the privacy policy.

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Upcoming Events

Dec 2

6:00 pm - 9:00 pm

Dec 3

12:00 pm - 1:00 pm

Foster Care Interest Meeting

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Physical Address: 630 North Elm Street • Greensboro, NC 27401
Mailing Address: P.O. Box 2993, Greensboro, NC 27402
(336) 275-9660 Toll Free: (800) 632-9312
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