Initial Treatment Parent Screening

Dear Potential Treatment Parent,

Thank you for your interest in becoming a Treatment Foster Parent with Alaska Child & Family! We are always excited to have new faces and energy to work with the youth we serve.

The licensing process is thorough to and typically takes 4 to 6 months from start to finish. We have included the initial screening questions and information about Treatment Foster Care, the services offered by our agency, and training.

Certain documentation is required by the State of Alaska, through the Office of Children’s Services and additional documentation is required by our agency. The State of Alaska paperwork includes:
Application for Foster Care License
Background Information for each applicant.
Clearance Form for each applicant.
Provider Emergency Response Information
Family Characteristics
Fire Evacuation Plan
Health History for each applicant.
Plan for Care AK Child & Child requires additional documentation to include:
Treatment Foster Care Application for each applicant
Casey Family Assessments In addition to required paperwork, AK Child & Family conducts interviews with the Licensing Department. Additionally requirements include:
Completing home visit from the licensing department
Completing fingerprints and background checks
Completing all necessary trainings for the State of Alaska and for Alaska Child & Family, including the Pressley Ridge training, Mandt and CPR/First aid.

The Licensing Department will assist in securing the documentation for your license, facilitating training, and ultimately recommend and submit your paperwork to the State of Alaska. During your tenure as a Treatment Foster Parent at AK Child & Family, the agency will hold your license, place students in your home, and supervise your license.

Your completed initial screening and additional paperwork may be submitted to the Licensing Department at AK Child & Family. Thank you again for your interest in becoming a foster parent!

Simcerely,

Kelsey Ledford

Community Programs
TFC Clinical Supervisor
(907) 792-4114

Date*

Date

Referred by

Applicant 1*

Date of Birth*

Date

Maiden/other names used

Applicant 2

DOB

Date

Maiden/other names used

Current Address*

School Zone*

Phone*

Email*

example@example.com

Do you live in the Anchorage Bowl?*

YesNo

Are you currently a licensed foster parent? If yes, why do you want to transfer*

Are you familiar with TFC? Why do you want to become a Treatment Foster Parent?*

What age range/gender would you be interested in working with?*

Who lives in your home and their ages?*

How many bedrooms do you have?*

Do you have any criminal convictions within the last 5 years?*

YesNo

Do you have a Child Protective Services history?*

YesNo

What is your/spouse occupation? Is it flexible?*

What is your working schedule?*

Do you have your own reliable transportation and insurance?*

YesNo

Do you have support from family and friends for supervision of youth?*

YesNo

Are you computer proficient?*

YesNo

Please describe your previous experience with documenting in an Electronic Health Record.*

Do you have a computer with internet at home?*

YesNo

Please describe your previous experience working with children.*

Do you have pets?*

YesNo

Do you smoke?*

YesNo

Have you been previously licensed to care for children or adults?*

YesNo

If yes, indicate city, state, and type of care and dates of licensure.

Have you ever had a license to care for children or adults revoked or denied in Alaska or any other state? If yes, attach an explanation.*

YesNo

Do you have a physical, health, mental, health, or behavioral problem that might pose a risk to the health, safety, or well-being of children?*

YesNo

Do you have a domestic violence problem or an alcohol or other substance abuse problem that might pose a risk to the health, safety or well-being of children? If yes, attach an explanation.*

YesNo

Have you been convicted of a crime or charged with a criminal offense listed as prohibited on the reverse of this form? If yes, attach and explanation.*

YesNo

Attach explanation document if applicable

Who holds your license and for how long?

Name and phone number for licensing worker:

How many foster children have you cared for at one time?

Were any of these foster children special needs or SED?

Initial Treatment Foster Parent Screening

If already licensed: