Foster Home Application

Foster Home Application

Animal Nation, Inc.
The first step in the process of becoming a foster home with Animal Nation, Inc. is to complete this application. The application provides important information. Working with you, we will be able to determine if the fostering is right for you. Please provide detailed information for all questions.

Please note that all foster homes are subject to a home visit at the discretion of Animal Nation. Primary applicant must be at least 18 years of age.

Page 1: Applicant Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Spouse/Partner

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-Mail Address*
Primary Phone Number*

Area CodePhone Number
Are you currently (check all that apply): *

Employed Full-TimeEmployed Part-TimeSelf EmployedUnemployedStudentRetiredOther
Employer (if employed):
Occupation:
Length of Employment with Current Employer:

Page 5: References
Please provide the names and contact information of two personal references, excluding immediate family members and those who reside at the address listed above.
Name*

First NameLast Name
E-Mail Address*
Phone Number*

Area CodePhone Number
Name*

First NameLast Name
E-Mail Address*
Phone Number*

Area CodePhone Number

Page 7: Authorization & Applicant Signature
I authorize Animal Nation, Inc., its volunteers, directors and designees to investigate all statements made on this application. I understand that the misrepresentation or omission of facts is cause for denial. My signature below indicates that all statements made are true and complete to the best of my knowledge.

Submitting this application shall constitute an electronic signature.
Should be Empty:

Page 6: Other Information