Foster parent applications : Youth Homes Inc.

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March 6--April 24, 2010

News

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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