Type of Position  
    Fulltime (Child Living in My Home)

Part time (Weekends or Hourly)

Both

 
               
 

Foster/Respite Parent Interest Form

                 
Demographics  
Identify "Primary Applicant" as the person who will spend the most time with a child in care.  
Applicant Name:

Co-Applicant Name:

Applicant Cell Number:

Applicant Email:
Applicant Age:

Co-Applicant Age:

Co-Applicant Cell Number:

Co-Applicant Email:
 
 Street Address:   City:  State:  ZIP:       
Are you a resident of NM? Yes  No  
Have you lived in NM for at least 5 years? Yes  No  
Do you have a current driver's license? Yes  No  
Do you have reliable transportation: Yes  No  
Are you currently employed outside the home: Yes  No  
        If Yes, Where do you work and what is your job title:
             
Home and Family        
Are you married? Yes  No    
       How long have you and the Co-Applicant been together?                    
Do you have children living in your home? Yes  No    
   

 If Yes - List the Names, Age and Gender of  your Children Living at Home 

               
       

 

                     
Are there any other adults living in your home (other than applicant and co-applicant)? Yes  No  
Do you understand that HDFS will do a criminal background check on each adult in the home? Yes No  
Do you own your home?  Yes  No  
Do you have pets?  Yes  No  
Do you smoke?  Yes  No  
Do you have a spare room?  Yes  No  
What ages of children are you interested in working with? 

What schools are in your District (Elementary, Middle, High)?
           
Experience, Strenghts, & Motivation            
 Have you ever applied to High Desert before? Yes No      
 Have you ever been a foster parent before?Yes No                        
      If yes, Please List Agency(ies) and how long ago
           
If you are currently licensed with another agency, do you have a current placement?  Yes  No  
Are you currently certified in CPR and First Aid?  Yes  No          
What languages are spoken in the home:               
Please describe in detail why you want to become a treatment foster parent or respite provider.          
What qualities do you possess that would make you a good foster parent? Please answer this question completely and thoughtfully.

 
How did you hear about our agency?

Comment 

 
                                       


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Revised: 07/13/18
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