Family Service Application

We take on new foster families as we have the funds to do so. As we receive applications, we review them, conduct interviews and choose families that we feel fit well with our program.

Please fill out the following application and we will contact you if we choose to move forward with your family.

Thank you so much for the hard work you’re doing as a foster family. YOU ARE A LIGHT TO THE WORLD!

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How many children live in your home?

Please specify biological/foster/adopted

Tell us a bit about your family and why you decided to do foster care.

How would our services benefit you?

Specify which services you’re most interested in.

Parental Make-up

Two Parents

Single Parent

Parental Occupations

Please list the occupations of the adults in the home.

Annual Household Income

What other services do you receive from non-profit organizations or government organizations?

Please include WIC, food pantries, clothing closets, church care, or gifts/services from any other non-profit agencies etc.

Are you currently in therapy?

Yes

No, but I would like to receive this service.

No, I would not benefit from this service.

In your opinion, what are some measurable indicators that services like ours are working well to improve your mental, emotional, physical and spiritual health?

What are other services that you feel could be beneficial to your mental, emotional, physical and spiritual health in order for you to raise healthy, well adjusted youth?

Family Service Application

FOSTER LIGHT