Home Study Autobiography
Resource Parent # 1
*
First Name
Middle Name
Last Name
Resource Parent # 2
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Assessor
*
Please Select
Christina Casey ccasey.familyadvocacysolutions@gmail.com
Cyndi McDaniel cyndi.familyadvocacysolutions@gmail.com
Cody Murray cody.familyadvocacysolutions@gmail.com
Renae Bueshausen renae.familyadvocacysolutions@gmail.com
Regina Bredenkamp regina.familyadvocacysolutions@gmail.com
Melissa Gasser mgasser.familyadvocacysolutions@gmail.com
Caylin Mertz caylin.familyadvocacysolutions@gmail.com
Kendra Richter kendra.familyadvocacysolutions@gmail.com
Wren Armstrong wren.familyadvocacysolutions@gmail.com
Winsley Dombroski winsley.familyadvocacysolutions@gmail.com
Mackenzie Ludemann mludem.familyadvocacysolutions@gmail.com
Cheryl Leffler
cheryl.familyadvocacysolutions@gmail.com
Questions must be answered by BOTH Resource Parents
Has either resource parent lived outside of Missouri in the past 5 years? If so, please list city and state.
Motivation to Foster: How and why you did become interested in fostering this child or children?
Attitude towards Fostering
Attitude towards Children: Describe what a child's role and responsibility should be within a family unit.
Attitude towards Children: How do you accept both your own and your children's positive and negative feelings?
Attitude towards Children: How are children involved in problem solving their own behaviors? Give examples.
Attitude towards Children: Describe your expectations of a child placed in your home including personality, achievement, behaviors, affectional response.
Attitude towards Children: How would you protect and nurture a child placed in your home?
Attitude towards Children: How would you protect and nurture a child placed in your home?
Type of Child(ren) desired: (ages, gender, number of children)
Special Considerations: What special needs are you willing to accept in your home?
Attitude toward Birth Parents: What are your thoughts on the significance of birth parents to foster children?
Attitude toward Birth Parents: How do you feel about birth parents? How will you work with birth parents?
Family Support for Fostering and Adopting: How does your extended family and friends support your fostering journey?
Resource Parent #1 Social History
Identifying Information: (age, description of person, character traits)
Family of Origin (Parents' names, mother's maiden name, siblings' names (list age of your siblings and where they live now); What type of relationship do you have with each sibling? Positive or negative?
Describe the place where you grew up. Where were you born? List all the places you lived and at what age.
Describe your parents' relationship as you perceived it in your childhood. If they are still married, how long have they been married.
If they are divorced, when did they get a divorce? How old were you? List any stepparents and describe your relationship with them growing up and now.
What are three words that describe your mother?
What was your relationship like with your mother growing up and now?
What does/did your mother do for a living?
What are three words that describe your father?
What was your relationship like with your father growing up and now?
What does/did your father do for a living?
Where do your parents currently live?
If you have stepparents, what was your relationship like with them growing up and now?
How did your parents show affection towards you and your siblings? How did your parents show their approval/disapproval toward you and your siblings?
How were you nurtured and protected?
When you were a child, who were you closest to in your family and why?
What chores did you have as a child?
What types of activities/hobbies/extracurricular activities did you participate in as a child/youth?
What did your family do for enjoyment? (recreational activities, vacations, etc)
Describe the role religion played in your upbringing.
What values did your parents teach you?
What would you change about your family life/family relationships growing up?
Describe any significant events, both positive and negative, experienced during your childhood. Please include when, where and with whom these events took place and the impact they had on you and your family.
Is there any history of the following in your immediate or extended family: emotional, sexual or physical abuse, neglect, drug use, alcohol abuse, spousal abuse, depression, emotional problems, violence and/or criminal activity? If yes, please explain.
Education
Where did you go to high school and/or college? (School names and location)
What is your highest level of education (degree)? What is your degree in? What year(s) did you graduate/earn your degree(s)?
Describe your academic performance (below average, average, above average). What areas did you struggle in? What areas did you excel in?
What types of school-related activities were you involved in?
Military History
Please identify your branch of service, highest rank, dates of entry and discharge and type of discharge.
Where were you assigned and how long did you serve each assignment?
If you have served in active duty military during war time, what effect did/does this have on you (emotionally, personally, spiritually)?
Description of Self
What do you like about yourself and what would you change about yourself?
What would you like to share about yourself?
What is your favorite leisure activity today? What extracurricular activities or hobbies do you participate in?
Health
Describe any serious illnesses or hospitalizations you experienced as a child, teenager or adult.
Describe your current physical and emotional health status.
Are there any current sources of stress in your life at this time? How are you handling this stress?
Who is your general physician? Are there any other health professionals you see on a regular basis (psychiatrist, therapist, chiropractor, etc).
Have you ever received any mental health treatment or treatment for an alcohol/substance abuse problem? If yes, please state the reason for seeking treatment including when and where the treatment was sought and the outcome.
Past Marital History: Include information for ALL previous marriages
What is/are the name(s) of your previous spouse(s)?
When and where were you married (month and year)?
How did the marriage end and when? (Death, divorce, etc).
What efforts were made to make the marriage work?
What children were born of this marriage? How old are the children now?
What efforts did/do you make to maintain a relationship between your children and your ex-spouse(s)?
List any other children you have, their names, ages, where they live and who is the other parent (if not listed in above questions).
Do you have a strained relationship with any of your children? If so, why?
Present Relationship
How and when did you first meet? If you are married, how long did you date before you were married? When did you get married?
What qualities about your partner made you want to marry or live with him/her?
How has your partner changed during your relationship?
What would you change about your partner? How could you change to improve your relationship?
What kinds of things do you disagree about? How do you settle those disagreements?
When do you spend time together? What do you do during this time?
Describe any difficult times in your relationship and how you worked through them.
Describe the roles that you and your partner have in the family (who is the disciplinarian, who manages the household, who is the money manager, who does tasks, chores, etc).
How do you think the addition of a foster child(ren)might change your relationship?
List any children born of your current relationship. Names, ages and where they live if not in your home.
Discipline and Behavior
What experiences have you had with children other than your own?
How were you disciplined as a child and by whom?
What feelings or thoughts do you have about these methods of discipline?
What types of behaviors or emotional issues do you expect a foster child to display?
What behavior do you feel is intolerable in a child?
How do you plan on addressing the behavioral and emotional issues of a foster child?
How will you help a child deal with their anger and frustrations?
What will you do if the behavioral or emotional issue persists or gets worse?
What types of discipline do you feel most comfortable with or prefer to use?
What kinds of discipline do you feel uncomfortable with or find unacceptable?
How will you discipline a foster child in your home?
Describe any medical issues and/or surgeries you have had either during your childhood or as an adult.
Have you ever received any mental health treatment or treatment for an alcohol/substance abuse problem? If yes, please state the reason for seeking treatment, when and where the treatment was sought and the outcome.
Resource Parent #2 Social History
Identifying Information: (age, description of person, character traits)
Family of Origin (Parents' names, mother's maiden name, siblings' names (list age of your siblings and where they live now); What type of relationship do you have with each sibling? Positive or negative?
Describe the place where you grew up. Where were you born? List all the places you lived and at what age.
Describe your parents' relationship as you perceived it in your childhood. If they are still married, how long have they been married.
If they are divorced, when did they get a divorce? How old were you? List any stepparents and describe your relationship with them then and now.
What are three words that describe your mother?
What was your relationship like with your mother growing up and now?
What does/did your mother do for a living?
What are three words that describe your father?
What was your relationship like with your father growing up and now?
What does/did your father do for a living?
Where do your parents currently live?
If you have stepparents, what was your relationship like with them growing up and now?
How did your parents show affection towards you and your siblings? How did your parents show their approval/disapproval toward you and your siblings?
How were you nurtured and protected?
When you were a child, who were you closest to in your family and why?
What chores did you have as a child?
What types of activities/hobbies/extracurricular activities did you participate in as a child/youth?
What did your family do for enjoyment? (recreational activities, vacations, etc)
Describe the role religion played in your upbringing.
What values did your parents teach you?
What would you change about your family life/family relationships growing up?
Describe any significant events, both positive and negative, experienced during your childhood. Please include when, where and with whom these events took place and the impact they had on you and your family.
Is there any history of the following in your immediate or extended family: emotional, sexual or physical abuse, neglect, drug use, alcohol abuse, spousal abuse, depression, emotional problems, violence and/or criminal activity? If yes, please explain.
Education
Where did you go to high school and/or college? (School names and location)
What is your highest level of education (degree)? What is your degree in? What year(s) did you graduate/earn your degree(s)?
Describe your academic performance (below average, average, above average). What areas did you struggle in? What areas did you excel in?
What types of school-related activities were you involved in?
Military History
Please identify your branch of service, highest rank, dates of entry and discharge and type of discharge.
Where were you assigned and how long did you serve each assignment?
If you have served in active duty military during war time, what effect did/does this have on you (emotionally, personally, spiritually)?
Description of Self
What do you like about yourself and what would you change about yourself?
What would you like to share about yourself?
What is your favorite leisure activity today? What extracurricular activities or hobbies do you participate in?
Health
Describe any serious illnesses or hospitalizations you experienced as a child, teenager or adult.
Describe your current physical and emotional health status.
Are there any current sources of stress in your life at this time? How are you handling this stress?
Who is your general physician? Are there any other health professionals you see on a regular basis (psychiatrist, therapist, chiropractor, etc).
Have you ever received any mental health treatment or treatment for an alcohol/substance abuse problem? If yes, please state the reason for seeking treatment including when and where the treatment was sought and the outcome.
Past Marital History: Include information for ALL previous marriages
What is/are the name(s) of your previous spouse(s)?
When and where were you married (month and year)?
How did the marriage end and when? (Death, divorce, etc).
What efforts were made to make the marriage work?
What children were born of this marriage? How old are the children now?
What efforts did/do you make to maintain a relationship between your children and your ex-spouse(s)?
List any other children you have, their names, ages, where they live and who is the other parent (if not listed in above questions).
Do you have a strained relationship with any of your children? If so, why?
Present Relationship
How and when did you first meet? If you are married, how long did you date before you were married? When did you get married?
What qualities about your partner made you want to marry or live with him/her?
How has your partner changed during your relationship?
What would you change about your partner? How could you change to improve your relationship?
What kinds of things do you disagree about? How do you settle those disagreements?
When do you spend time together? What do you do during this time?
Describe any difficult times in your relationship and how you worked through them.
Describe the roles that you and your partner have in the family (who is the disciplinarian, who manages the household, who is the money manager, who does tasks, chores, etc).
How do you think the addition of a foster child(ren)might change your relationship?
List any children born of your current relationship. Names, ages and where they live if not in your home.
Discipline and Behavior
What experiences have you had with children other than your own?
How were you disciplined as a child and by whom?
What feelings or thoughts do you have about these methods of discipline?
What types of behaviors or emotional issues do you expect a foster child to display?
What behavior do you feel is intolerable in a child?
How do you plan on addressing the behavioral and emotional issues of a foster child?
How will you help a child deal with their anger and frustrations?
What will you do if the behavioral or emotional issue persists or gets worse?
What types of discipline do you feel most comfortable with or prefer to use?
What kinds of discipline do you feel uncomfortable with or find unacceptable?
How will you discipline a foster child in your home?
Describe any medical issues and/or surgeries you have had either during your childhood or as an adult.
Have you ever received any mental health treatment or treatment for an alcohol/substance abuse problem? If yes, please state the reason for seeking treatment, when and where the treatment was sought and the outcome.
Foster Parent Lifestyles
Please describe what a typical day looks like in your household.
What does your family do together for enjoyment? What special activities or vacations?
What interests does your family have in common (books, games, movies, TV shows, hobbies)? What types of things does everyone like to do together?
What traditions does your family have for birthdays or other special occasions?
What holidays does your family celebrate? What traditions do you have for those holidays?
Who of your family and friends will be a support to you through the fostering process?
Religious Practices
What particular religious or spiritual beliefs/practices/observations do you participate in?
If you are a member or attend a certain church/place of worship, what is its name and how often do you attend?
Would you accept a child from a different denomination than your own? A different faith?
Would you be willing to take a child to a church of a different faith or denomination if the biological parents or the child preferred?
Childcare Arrangements
What flexibility in your employment would you have if you had a sick child at home or had to stay home with a child ?
If you work, where will the child(ren) go after school if they are not daycare age?
Home and Community
Please describe your home; how many rooms, bedrooms, bathrooms, etc?
Describe the space a foster child(ren) will have in your home. What size bed do they sleep in?
Describe your community.
Describe your pets. What are their names? What kind of animals are they? Who and where is your vet? Are they up to date on shots?
Education
What is your preference of schooling (public, private, home schooling)? Why?
What school district do you reside in? What elementary and/or high school will the child attend/
What are your thoughts about the importance of education for a child's future?
Finances
Employment Information for each Resource Parent (Name of employer, start date, address, phone number, position, hours per week, work days)
Do you own or rent your home?
Who manages the income, pays the bills, makes financial decisions?
What financial stress are you currently under?
Have you ever filed for bankrupty?
5 Competencies
Protecting and nurturing children.
Children placed with foster families and adoptive families need to live in a safe place that keeps them from harm, is friendly, and where the parents show they care. Some children who have not been kept safe or cared for may not accept or understand the efforts to do so at first. Others are hungry for attention. Foster parents need to understand a child's feelings and reactions to separation and deal with those feelings and reactions appropriately.
Please provide examples of your strengths in this area and how you will demonstrate competency with the foster children in your home.
What needs do you have in this area?
Meeting children's developmental needs and addressing developmental delays
For most of us, growing up is a natural, predictable development process. For example, infants who have the opportunity and encouragement to walk at the right stage of their development will learn how to walk. Many of the children who need foster families or adoptive families did not have the opportunity or encouragement to grow by learning how to do things at the "right" time in their development. They may be "behind" in some ways or "ahead" in others compared to children of the same age who had their developmental needs met. Foster parents need to understand the reasons for these developmental delays and differences and how to cope with them.
Please provide examples of your strengths in this area and how you will demonstrate competency with the foster children in your home.
What needs do you have in this area?
Supporting child and family relationships
Birth family relationships include brothers, sisters and other relatives as well as parents. Children do not arrive at the door of a foster family or adoptive family without bringing some kind of personal history with them. Even infants who have never been held by their parents have a prenatal, birth or hospital history. The memories, experiences and attachments children bring with them will vary, but they will come with the child. Foster parents need to understand and support the importance of a child's history and help the child understand it.
Please provide examples of your strengths in this area and how you will demonstrate competency with the foster children in your home.
What needs do you have in this area?
Connecting children to safe, nurturing relationships intended to last a lifetime
Children's Division believes-and the law requires-that children are entitled to permanent, lifetime family relationships. Children's Division works with parents to correct issues so children can return home if possible. If the parents cannot or do not respond, the agency looks for another permanent family for the children.
Please provide examples of your strengths in this area and how you will demonstrate competency with the foster children in your home.
What needs do you have in this area?
Working as a member of a professional team
Whatever a child's circumstances, needs, or past experiences, the Children's Division and foster parents must work together for the child's benefit.
Please provide examples of your strengths in this area and how you will demonstrate competency with the foster children in your home.
What needs do you have in this area?
Identifying Information: (age, description of person, character traits)
Family of Origin (Parents names, siblings names (list age of your siblings and where they live now); What type of relationship do you have with each sibling? Positive or negative?
Describe the place where you grew up. Where were you born? List all the places you lived and at what age.
Describe your parents' relationship as you perceived it in your childhood. If they are still married, how long have they been married.
If they are divorced, when did they get a divorce? How old were you? List any stepparents and describe your relationship with them.
What are three words that describe your mother?
What did your mother do for a living?
What was your relationship like with your mother growing up and now?
What are three words that describe your father?
What did your father do for a living?
What was your relationship like with your father growing up and now?
Where do your parents currently live?
If you have stepparents, what was your relationship like with them growing up and now?
How did your parents show affection towards you and your siblings? How did your parents show their approval/disapproval toward you and your siblings?
How were you nurtured and protected?
When you were a child, who were you closest to in your family and why?
What chores did you have as a child?
What types of activities/hobbies/extracurricular activities did you participate in as a child/youth/adolescent?
What did your family do for enjoyment? (recreational activities, vacations, etc)
Describe the role religion played in your upbringing.
What values did your parents teach you?
What would you change about your family life/family relationships growing up?
Describe any significant events, both positive and negative, experienced during your childhood. Please include when, where and with whom these events took place and the impact they had on you and your family.
Is there any history of the following in your immediate or extended family: emotional, sexual or physical abuse, neglect, drug use, alcohol abuse, spousal abuse, depression, emotional problems, violence and/or criminal activity? If yes, please explain.
Education
Where did you go to high school and/or college? (School names and location)
What is your highest level of education (degree)? What is your degree in? What year(s) did you graduate/earn your degree(s)?
Describe your academic performance (below average, average, above average). What areas did you struggle in? What areas did you excel in?
What types of school-related activities were you involved in?
Military History
Please identify your branch of service, highest rank, dates of entry and discharge and type of discharge.
Where were you assigned and how long did you serve each assignment?
If you have served in active duty military during war time, what effect did/does this have on you (emotionally, personally, spiritually)?
Description of Self
What do you like about yourself and what would you change about yourself?
What would you like to share about yourself?
What is your favorite leisure activity today? What extracurricular activities or hobbies do you participate in?
Health
Describe any serious illnesses or hospitalizations you experienced as a child, teenager or young adult.
Describe your current physical and emotional health status.
Are there any current sources of stress in your life at this time? How are you handling this stress?
Who is your general physician? Are there any other health professionals you see on a regular basis (psychiatrists, therapists, chiropractors, etc).
Have you ever received any mental health treatment or treatment for an alcohol/substance abuse problem? If yes, please state the reason for seeking treatment including when and where the treatment was sought and the outcome.
Present Relationship
How and when did you first meet? If you are married, how long did you date before you were married?
What qualities about your partner made you want to marry or live with him/her?
How has your partner changed during your relationship?
What would you change about your partner? How could you change to improve your relationship?
What kinds of things do you disagree about? How do you settle those disagreements?
When do you spend time together? What do you do during this time?
Describe any difficult times in your relationship and how you worked through them.
Describe the roles that you and your partner have in the family (ex. who is the disciplinarian, who manages the household, who is the money manager, who does tasks, chores, etc).
How do you think the addition of a foster child(ren)might change your relationship?
List any children born of your current relationship. Names, ages and where they live if not in your home.
Past Marital History: Include information for ALL previous marriages
What is/are the name(s) of all your previous spouses?
When and where were you married (month and year)?
How did the marriage end and when? (Death, divorce, etc).
What efforts were made to make the marriage work?
What children were born of this marriage? How old are the children now?
What efforts did/do you make to maintain a relationship between your children and your ex-spouse?
List any other children you have, their names, ages, where they live and who is the other parent (if not listed in above questions).
Do you have a strained relationship with any of your children. If so, why?
Discipline and Behavior
What experiences have you had with children other than your own?
How were you disciplined as a child and by whom?
What feelings or thoughts do you have about these methods of discipline?
What types of behaviors or emotional issues do you expect a foster child to display?
What behavior do you feel is intolerable in a child?
How do you plan on addressing the behavioral and emotional issues of a foster child?
How will you help a child deal with their anger and frustrations?
What will you do if the behavioral or emotional issue persists or gets worse?
What types of discipline do you feel most comfortable with or prefer to use?
What kinds of discipline do you feel uncomfortable with or find unacceptable?
How will you discipline a foster child in your home?
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