Foster Family Interest Form

Applicant Name:

Address:

City:

State:

Postal Code:

Cell Phone:

Work Phone:

Home Phone:

* Email Address:

How Did You Learn of Family Resources Community Action?:

Are you at least 21 years of age?:

Do You Have a Valid RI Driver’s License?:

Do You Have Reliable Transportation?:

Do You Have Appropriate Space for a Foster Child? (50 square feet/child):

Do You Have a Spare Bed for the Foster Child?:

Are You Financially Stable without Reliance on the Foster Care Board Rate?:

What is Your Current Work Schedule/Other Commitments?:

Are you able to communicate in English?:

YesNo

Are you Bilingual?:

Do You Have Smoke Detectors?:

Do You Have Fire Extinguishers?:

Do You Have a Remote Boiler Switch?:

Have You Ever Applied to Become a Foster Parent with Another Agency?:

If Yes, Please List.:

Please List All Household Members and Their Ages:

Age of Foster Child:

Please enter the characters in the image:

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