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- Race*
- Gender*
- Date of Birth*
- Today
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- Do you receive a daily (per diem) or monthly subsidy amount from DFCS for the care of this child? (including TANF or child Social Security Benefits or Child Support payments)*
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- Have you ever in the past received a daily (per diem) or monthly subsidy amount from DFCS for the care of this child? (including TANF or child Social Security Benefits or Child Support payments)*
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- Date Entered into Foster/Relative Care*
- Date Entered into your home (*could be the same date as above)*
- Has the 72 hour hearing occurred? (when a child enters foster care, a court hearing must occur within 72 hours)*
- This child’s case is handled by a…. (select all that apply)*
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Format: (000) 000-0000.
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Format: (000) 000-0000.
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- Have parental rights been terminated (TPR) or surrendered by the biological parents?*
- Will your home be the child’s adoptive home?*
- Do either of the child’s biological parents live in the same home as the child, either part-time or full-time?*
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- Child's Stature*
- Hair Type (select all that apply)*
- Hair Accessory Preference*
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- Underwear/Diaper/Pullup Preference:*
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- Shoe Width Preference*
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- Bra Preference*
- Boot Preference (subject to availability/season)*
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- Would you like to add another child to this application?*
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