Questionnaire for Foster Care
Thank you for your interest in foster care. Please complete the form and our Foster Home Licensing Team will contact you with more information soon.
Name of Caregiver #1
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
When is the best time to call?
How did you hear about Heartland for Children? (Select as many as you want)
Internet Search
Social Media
Poster/Flyer
Radio
Family/Friend
Church
Foster Parent
Bus Advertisement
Billboard
Other
What is your relationship status?
Single
Married
Roommates
Divorced
Separated
Significant Other
Name of Caregiver #2 (If Applicable)
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What's your motivation to foster?
Have you ever been licensed to foster or adopt in Florida or another state?
Yes
No
If so, when and where?
How many children under the age of 18 are living with you?
0
1
2
3
4
5+
Have you ever been licensed or attempted to be a licensed home daycare?
Yes
No
Have you or anyone in your family ever had an investigation or allegation of abuse or neglect?
Yes
No
Has any member of your household ever been convicted for a crime?
Yes
No
Does your income cover your expenses?
Yes
No
Do you receive financial support from any of the following sources?
No
Food Stamps
Section 8
AFDC
Foster parents are required to provide transportation for the children in their care. Do you have a vehicle, valid drivers license and current auto insurance?
Yes
No
How many seats are in your vehicle?
Does at least one adult wanting to be licensed speak, read, write and understand English?
Yes
No
What age range would you like to foster? (You can select more than one)
0-5
5-10
10-15
15-21
Please indicate if you're willing to foster a sibling group.
No, I'm not willing to foster a sibling group.
2 siblings
3 siblings
4 siblings
5+ siblings
How many children are you willing to foster at one time?
Do you have any comments or questions?
Submit
Should be Empty: