Foster parent applications : Youth Homes Inc.

Courage House Awards Luncheon
Tuesday, November 2, 2010

News

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Youth Homes Inc. merges with Children's Home Society and Family Life Council. Click here for more on this exciting news!

How did you hear about Youth Homes?
TV: Radio: What Station:
Community Event: What Event: Billboard
Black Pages Yellow Book Charlotte Parent Magazine Internet YHI PP
Name Other:
Prospective Professional Parent Information:
Name Email: Date of Birth
Race:
Home Address Zip: City: State:
Home Phone Number
Occupation/Place of Employment
Work Phone Number
How long have you been married?

Spouse Name Date of Birth
Race:
Spouse Occupation/Place of Employment
Spouse Work Number
Do you have any children? Yes No
If yes how many live at home:
Are you a Legal Resident of The United States? Yes No
Can at least 1 adult member of the household speak English fluently? Yes No
Have you been or are you currently a foster parent for another agency?: Yes No
If yes which agency? When
Do You Have A Valid Driver's License? Yes No
Do You Have Your Own Transportation? Yes No
Do You Have A High School diploma or GED? Yes No
Have You Received Any Kind of Government Subsidy (food stamps, TANF, Section 8 housing) within the past twelve Months? Yes No
Do You Have Any Criminal Convictions? Yes No
If yes, When: Explain
Has the Dept. of Social Services ever investigated your home? Yes No
If yes, explain (When, why, outcome)
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