COASTAL BEHAVIOR HEALTH SERVICES, INC.
PO Box 53
Wade, NC 28395
(910) 484-8869
CONFIDENTIAL:
Your Name
First Name
Last Name
Your Email
example@example.com
FOSTER HOME REFERENCE
Foster Parent Applicant Name
1. How long have you known the family?
2. In what capacity? (friend, pastor, etc.)?
3. Do you know all the family members well?
4. How well do you feel you know them?
5. How would you characterize the relationship between the husband and wife?
6. How would you characterize the relationship between the husband/father and children?
7. What about the wife/mother and children?
8. What qualities of this family do you admire the most?
9. How does this family handle disappointments, stress, frustration and crisis?
10. How do you feel they are able to relate to children?
11. Do you know any reason why this family would not suitable to care for Foster Children? If so, please discuss being very specific.
12. And additional comments or observation:
Signature
Date
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Month
-
Day
Year
Date
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