Orientation Pre-Questionnaire
Want to learn more about foster care or adoption? Fill out this form and once you press submit, you will receive an invitation to our upcoming orientation to learn more!
How did you hear about Orchards?
Website/Internet Search
Social Media
Foster Parent
Orchards Employee
Friend/Family Member
Daimler Chrysler/Detroit Diesel Event
Church/Religious Organization
Flyer/Bookmark
Organization/Agency/Foster Care Navigators
Metro Parent Email/Informational Email
Community Event
Other
2. If you heard about Orchards from a licensed foster parent at Orchards, enter their name below:
3. Please write out applicant #1's full name:
Mr.
Mrs.
Ms.
Prefix
Legal First Name
Maiden Name
Last Name
Please write out applicant #2's full name:
Mr.
Mrs.
Ms.
Prefix
Legal First Name
Maiden Name
Last Name
4. Marital Status:
Married
Single
Widowed
Divorced
Separated
Live in Partner
5. Please write out your home address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
6. Primary Phone:
-
Area Code
Phone Number
Primary Email Address:
example@example.com
7. Please list ALL persons living in the home. Please list each individual’s name, role (father, mother, daughter, etc.):
First Name
Last Name
Role/Relationship
First Name
Last Name
Role/Relationship
First Name
Last Name
Role/Relationship
First Name
Last Name
Role/Relationship
First Name
Last Name
Role/Relationship
First Name
Last Name
Role/Relationship
10. Are you a current licensed foster parent?
Yes
No
If yes, what is the name of the agency?
11. What are your licensing and placement interests? (select all that apply)
Fostering children ages 0-3
Fostering children ages 4-9
Fostering children ages 10-12
Fostering children ages 13-17
Independent Living Program (Children ages 16+)
Adoption only, children ages 10+
Fostering or adopting a specific child or relative. If so, please add their name in "other" below
I am interested in caring for a child/youth with medical needs
I am interested in caring for a child/youth with emotional/mental health or other special health needs
I am interested in caring for a child/youth with behavioral needs
Temporary foster care with birth parent visits
Temporary foster care with birth parent visits and hopes to adopt in the future
Other
12. How many bedrooms do you have in your home?
1 Bedroom
2 Bedrooms
3 Bedrooms
4 Bedrooms
5+ Bedrooms
Submit
Should be Empty: