Prospective Foster Parent Application

Applicant #1 Name

First Name *

Last Name *

Applicant #2 Name

First Name *

Last Name *

Address

Country

Address Line 1 *

Address Line 2

City *

State/Province *

Postal Code *

County

Home Phone

Cell Phone

Work Phone

ext Extension

Email Address

Current Marital Status

Married
Single
Widowed
Divorced

Do you have a Social Security or valid ITIN number?

Yes, Social Security
Yes, ITIN
No

How long have you lived at your current address? (If less than 5 years, answer next question)

How many addresses have you had in the last 5 years?

Type of residence

Apartment
Condo
House
Townhouse

How many bedrooms are in your home?

How many are open?

Do you own your home?

Yes
No

If you rent, would a landlord approve of foster children in your residence?

Yes
No

How many of your own children )biological/adopted/step) under the age of 18 live in your home?

List names and ages of the children

Are any of these children specialized?

Yes
No

If yes, states the needs of the specialized children

Do any adults reside in your home?

Yes
No

If yes, list relationship and ages

I own own a vehicle, drive, and have a valid Illinois driver's license and automobile insurance

Yes
No

If married, do both have above?

Yes
No

I am currently licensed as a foster parent

Yes
No

If yes, with what agency? Include address and contact person.

I have fostered before

Yes
No

I was licensed in the following years:

I currently currently have children placed in my home

Yes
No

If yes, how many?

What is the status of the children placed in your home? (adoption, return home, etc)

How many children have you fostered?

What happened to them? (return home, guardianship, 14 day notice)

If a 14 day notice, what happened? Have you ever had your home on hold?

I have fostered any children besides the ones described above

Yes
No

I have fostered children with specialized needs

Yes
No

I am leaving my current foster agency because:

I have completed Foster Parent Pride

Yes
No

I have a certificate

Yes
No

What special talents do you think that you possess that have you prepared to foster a child with special needs?

Occupation of Applicant #1

My work schedule is:

How long have you worked at your job?

If less than 3 years, how many jobs have you held in the past 5 years?

I am able to provide proof of income in the form of 3 recent pay stubs and tax information from the previous year?

Yes
No

Occupation of Applicant #2

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My work schedule is:

How long have you worked at your job?

If less than 3 years, how many jobs have you held in the past 5 years?

I am able to provide proof of income in the form of 3 recent pay stubs and tax information from the previous year

Yes
No

I pay my own utility bills (lights, gas, etc)

Yes
No

If so, will you be able to provide a copy of them to us? They must be in your name.

Yes
No

My household is vaccinated against COVID-19

Yes
No

I want to become a UCP Seguin foster parent because:

What kind of foster child are you interested in working with? (State age range, gender of child and medical/behavioral conditions)

How did you hear about foster care opportunities at UCP Seguin?

If Other, Please Indicate Where

If Referred By Employee, Foster Parent or Participant/Family, Please Note Their Name:

Please Type Your Full Legal Name and Date

Prospective Foster Parent Application

Applicant Information

Home Information

Family Information

Vehicle Information

Experience

Employment Information

Additional Information

Disclaimer And Signature