Foster/Adoptive Family Application Applicant Information "*" indicates required fields NameThis field is for validation purposes and should be left unchanged.County* Bond County Clinton County Franklin County Greene County Hamilton County Jackson County Jefferson County Jersey County Johnson County Madison County Marion County Monroe County Saline County St. Clair County Washington County Wayne County Williamson County Your full name* First Last Preferred NameSpouse's Name (if applicable) First Last Spouse's Preferred NamePhone Number*Email Address(es)* Address* Street Address City* City Zip Code* ZIP / Postal Code Church Affiliation (if applicable)Licensing Agency*Licensing Worker's Name* First Last Phone Number*Check the option that applies to you* I am enrolled in PRIDE training to become a foster parent. I am currently a foster parent. If currently licensed, approximately what date did you receive your foster care license? MM slash DD slash YYYY What is (will be) the age range on your license?*What is (will be) the gender preference, if any, on your license?*What is (will be) the capacity on your license?*Children in Your Home: Please provide the first name, gender, and birthdate for each child currently in your home and note if child is biological, fostered, or adopted.*Occupation/Availability: For each applicant, please indicate your occupation and work schedule.*Please briefly describe your motivation for becoming a foster parent.*Please briefly describe any prior experiences with foster care or adoption.*By becoming a Restore Network family, I acknowledge that the Restore Network works closely with child welfare agencies across the state to ensure safe placement of children into foster homes. I understand the Restore Network is often contacted by these agencies to help find homes that will be a good fit for their children. I give consent to the Restore Network to communicate with agencies about my family should staff believe that we might be a good fit for a child(ren), recognizing that I have the final stay in who I welcome into my home. I also consent to the Restore Network staff working together with our agencies after placement, to ensure adequate supports for our family and the safety and care of the child(ren) placed with us for as long as they reside in our home as a foster child(ren).* I consent. I would like to be a Restore Network family with all the supports available in my county.* Yes No Today's Date:* MM slash DD slash YYYY Name of Person Completing Application*CAPTCHA Protected Δ
