• West Virginia Foster Parent Application

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  • *The National Youth Advocate Program does not discriminate against in the provision of services on the basis of religion, race, color, creed, gender, gender identity/expression, sexual orientation, national origin, age, disability, ability to pay, or HIV/AIDS status.

  • HEALTH OF FAMILY MEMBERS

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  • MONTHLY FINANCIAL STATEMENT

    Sources of Income/Expenditures:
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  • REFERENCES

    Please list 6 references (1 can be relatives)
  • EMPLOYMENT HISTORY

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  • WAIVER OF ACCESS OF RECORDS AND AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFOMRATION

  • I understand that the National Youth Advocate Program will not divulge any information obtained in the process of determining my compliance with all regulations covering foster parents in the State of West Virginia. I further understand that the National Youth Advocate Program will request information pertaining to my background and character. Such may involve contacting reference, creditors, neighbors and employers, past and present.

    I hereby waive my right of access to any and all records of this nature and give my consent to all agencies contacted by the National Youth Advocate Program for release of information for the duration of the profile process.

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