Foster Care Application

Foster Care Application

The Good Shepherd Family Services
FFA:
After filling out this form, we will generate 5 different PDF Forms that will require your signature. Please complete the form as accurately as possible as it will be converted to California Department of Social Services forms.
Applicant (1)

This will be the Primary Caregiver
Application
NoIf “Yes” provide name of the Tribe and contact information if known:
Applicant 1 (Legal Name):*

First NameMiddle NameLast Name
Preferred/Chosen Name:

First NameLast Name
Previous Name Used: *including maiden name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Cell Phone Number*
Format: (000) 000-0000.
Home Phone Number
Format: (000) 000-0000.
Gender*
Race/Ethnicity*
Highest Level of Education Completed*
Drivers License Number*
Email Address*
Name of Employer*
If not currently employed, indicate "Unemployed"
Address of Employer*
Work Phone Number*
Format: (000) 000-0000.
Occupation*
Job Title / Position
Annual Income*
Upload Driver's License*

Cancelof
YesNo
Remember: You can save this form at anytime and get back to it later.
Name
DOB
Gender
Ethnicity
Marital Status
Address
Name
DOB
Gender
Ethnicity
Marital Status

References
Reference 1

Please list the name, phone number, address of two individuals who have knowledge of your home environment, lifestyle and ability to be a Resource Family
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

CityState / Province

Postal / Zip Code
Reference 2

Please list the name, phone number, address of two individuals who have knowledge of your home environment, lifestyle and ability to be a Resource Family
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

CityState / Province

Postal / Zip Code

Relationship History

Rows	Child's Name	Relationship to Child	Date of Birth	Gender	Check Box If You Provide Financial Support To This Child
Child 1
Child 2
Child 3
Child 4