Jot Form Pre App foster care

Date

MonthDayYear
Date
Applicant 1 Full Name (including maiden)
Applicant 2 Full Name (including maiden)
Full Home address, Street number and name, city and zip code
Home telephone number
How long have you resided in the State of Oklahoma?
Have you lived in a state other than Oklahoma in the past 5 years? If yes, please list the states you have lived in in the past 5 years.
Applicant 1 cell number
Applicant 2 cell number
Email address
example@example.com
Email Address
Names and age of children (please indicate if they live in your home)
How were you referred?
Annual Household income
Applicant 1: Have you ever been arrested, have any type of criminal record, or child welfare history?
If yes, please explain
Applicant 2: Have you ever been arrested, have any type of criminal record, or child welfare history?
If yes, please explain
Do you have a history of adoption or foster care? If so, please describe briefly.
What is your perspective of a child's biological parents?
What is your motivation to become foster parents?
Any other comments or information you would like to add
Applicant 1 Signature

Clear
Date

MonthDayYear
Date
Applicant 2 Signature

Clear
Date

MonthDayYear
Date
Date Pre Application Received- Agency use ONly

MonthDayYear
Date
Date Reviewed by Director

MonthDayYear
Date
Pre approval Date

MonthDayYear
Date
Foster Care Specialist Assigned
Should be Empty: