ABC Foster Questionnaire

How You May Become Certified


	1. Have you ever been certified as a foster parent before?	Yes No
	2. Name of Agency or Facility Name.
	3. Are you 21 or over?	Yes No
	4. What county do you live in?
	5. Are you or the other prospective foster parent employed?	Yes No
	6. How many bedrooms do you have in your home?
	7. How many adults and children live in your home?
	8. If not employed, what is your or other prospective foster parent's source of income?
	9. All adults 18 years or older that permanently reside in the home must have a finger print clearance and a child abuse clearance, would this be a problem?	Yes No
	10. Have you or or any other adult (18 years or older that permanently live in the household) ever been arrested?	Yes No
	11. All adults living in the household that are 18 years or older must have a health screening and a T.B. test. Would this be a problem?	Yes No
	12. How did you hear about ABC-FFA?
	13. Please provide your Name.
	14. Please provide your Street Address.
	15. Please provide your City, State & Zip.
	16. Please provide your Telephone Number.
	17. When is the best time for an ABC-FFA employee to reach you?