Providing safe and healthy homes for children of families in crisis.

Donate

Host Family Application – Applicant 2

"*" indicates required fields

If you need to leave this form, please use the Save and Return button at the end of the form. If you do not activate the Save and Return feature, you will lose your data.
Applicant 2 - Full Name*
Applicant 2 Maiden Name - if Applicable
MM slash DD slash YYYY
Applicant 2 Gender*
US Citizenship*

Employment

Work Status

Do you work swing/night shifts?

Relationships

Marital Status*

Volunteer Experience and Community Support

Do you have any experience working or volunteering with children?*
Do you have any experience working with vulnerable children and families?*
Have you ever been a foster parent or had any interest in becoming one?*
Do you have any training or experience working with special needs children?*
Do you have family or friends that are supportive to you?*
Are you connected to a small group/life group?*

Background Disclosure & Consent

All adults (over the age of 18) will be required to complete a LiveScan fingerprint clearance. If any box below is checked yes, please indicate the nature and circumstances of the original incident(s) in the space provided below. Include the date, place and the name off the individual that the incident applies to.
Have you ever been arrested, cited, convicted or currently facing charges for ANY law enforcement offense?*
.
Are you currently or previously been on parole or probation for an offense?*
Have you had any child removed from your care due to abuse or neglect?*
Have you ever been deprived of parental rights or had your rights restricted?*
Have you ever had your driver's license suspended?*
Consent*
Consent*
Consent*
Consent*
Drop files here or
Max. file size: 80 MB.