FCSA Foster Parent Application
Personal Info
Parent 1
Name of Applicant
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Date of birth
*
Please select a month
January
February
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Month
Please select a day
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Day
Please select a year
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1922
1921
1920
Year
How long have you lived in Alaska?
*
Current Employer
*
Job Title
*
Approximate length of employment?
*
Work Schedule (days and times)?
*
Level of education
*
List degree and field
Parent 2 (Optional)
Name of Applicant
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of birth
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
How long have you lived in Alaska?
Current Employer
Job Title
Approximate length of employment?
Work Schedule (days and times)?
Level of education
List degree and field
Other parent info
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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FCSA Foster Parent Application
Experience working with youth
Please provide a brief summary of parent #1's background and experience working with youth
*
This can include past foster parent experience, work experience, etc.) Please list approximate dates
Please provide a brief summary of parent #2's background and experience working with youth
This can include past foster parent experience, work experience, etc.) Please list approximate dates
Please list the name and age of any children or other people living in your home:
*
Please list if there are any physical, mental, emotional, or other health status information of anyone living in the home that may affect your family's ability to parent a foster child:
*
Were you previously licensed as foster parents?
*
Yes
No
State you were licensed in and the name of the agency
*
Rows
State
Agency
State and Agency
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Approximate start date
*
-
Month
-
Day
Year
Date
Approximate end date
*
-
Month
-
Day
Year
Date
Can you provide us a copy of your license?
*
Yes
No
If previously licensed, have you ever been investigated by the Office of Children's Services (OCS) or another child welfare agency?
*
Yes
No
Please explain thoroughly and list if it was substantiated or unsubstantiated
*
Why do you (parent #1) want to be a foster parent?
*
Why do you (parent #2) want to be a foster parent?
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FCSA Foster Parent Application
Daily schedule
Parent #1, list your typical daily schedule. Please include: when you leave for work, when kids leave for school, when each get home, any evening schedule and when kids go to bed
*
Parent #2, list your typical daily schedule. Please include: when you leave for work, when kids leave for school, when each get home, any evening schedule and when kids go to bed
Kids Daily Schedule
*
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FCSA Foster Parent Application
Parenting practices
What types of activities do you do as a family and do with foster children? Please include any school, community and cultural involvement.
*
What type of supervision plan would you have for your foster children (who supervises them and when)? Please be specific.
*
What type of parenting practices and discipline do you use with children? Do you use positive reinforcement, natural consequences, etc.? Any special rewards you use? Please describe
*
How do you feel about working with foster children who have committed delinquent acts or who have been subjected to abuse, neglect, separation from, and loss of their biological family?
*
How do you feel about working with birth families of foster children? Do you feel you could have an on-going relationship with a birth family?
*
What do you feel are your family strengths? What areas do you feel you may need more support or training in?
*
Do you have any experience with Electronic Medical Records? (Please note that FCSA Foster Parents must do daily documentation.)
*
Parent #l - Certified in CPR/First Aid?
*
Yes
No
Parent 1, do you have any other special skills?
*
Yes
No
Parent #l, please describe your special skills below
*
Parent #2 - Certified in CPR/First Aid?
Yes
No
Parent 2, do you have any other special skills?
Yes
No
Parent #2, please describe your special skills below
Please list all the pets in the home
*
Are they Immunized and current with all shots?
*
Yes
No
Have there been any incidents of aggressive behaviour or biting?
*
Yes
No
Description of incident
Please list the number of bedrooms in your home and the sleeping arrangements for everyone. Will foster child have their own bedroom? Do kids share a bedroom?
*
Do you have any firearms in your home? If yes, how are they stored? (Guns must be stored in a locked cabinet or area and ammo must be stored and locked separately
*
Where do you store your medications? (Medications must be locked up)
*
Where do you store your cleansers? (Cleaners must be locked up)
*
If you have flammable liquids, where are they stored? (Flammable liquids must be locked up)
*
Additional Comments
*
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*
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