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
Format: (000) 000-0000.
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
Date

MonthDayYear
Date
Applicant 2 Signature
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: