Foster Parent ApplicationFoster Parent ApplicationFill out this form to apply to become a foster parent today. If you have any questions about the application process, please contact us at 402-434-5437 or info@cedarskids.org. First Name *Last Name *Phone Number *Email Address *My preferred method of communication is: *PhoneEmailBirthdate *Highest Level of Completed Education *Some High School, No DiplomaHigh School Graduate, Diploma or GEDSome College Credit, No DegreeTrade or Technical TrainingAssociate DegreeBachelor's DegreeMaster's DegreeProfessional DegreeDoctorate DegreeAre you at least 21 years of age? *YesNoAre you a U.S. citizen or otherwise authorized to work in this country? *YesNoI'm not sureI heard about CEDARS Foster Care Program from: *- Select -List which Community Event/Speaker Engagement below:Please list their name(s) below:Please List their Name(s) Below:Have you applied to be a foster parent with CEDARS before? *YesNoI'm not sureWhen?Have you ever been a foster parent in the past? *YesNoWhich agency?Why did you close your license?Do you have any pending charges of a violation of law other than a minor traffic violation? *YesNoHave you ever been convicted of a violation of law other than a minor traffic violation? *YesNoHave you ever been investigated or have you had an open CPS case? *YesNoPlease explain:I am interested in (check all that apply) *FosteringAdoptionRespite CareSupporting Biological FamiliesInfants - Pre-KSchool Age ChildrenTeensSiblingsChildren Learning English as a Second LanguageHelping in the Area of Greatest NeedKids with Significant Medical NeedsKids with Significant Mental Health NeedsApplicant 2 (If applicable)First Name (Applicant 2)Last Name (Applicant 2)Phone Number (Applicant 2)Email Address (Applicant 2)Birthdate (Applicant 2)Highest Level of Completed Education (Applicant 2)Some High School, No DiplomaHigh School Graduate, Diploma or GEDSome College Credit, No DegreeTrade or Technical TrainingAssociate DegreeBachelor's DegreeMaster's DegreeProfessional DegreeDoctorate DegreeAre you at least 21 years of age? (Applicant 2)YesNoAre you a U.S. citizen or otherwise authorized to lawfully work in this country? (Applicant 2)YesNoI'm not sureHave you applied to be a foster parent with CEDARS before? (Applicant 2)YesNoI'm not sureWhen? (Applicant 2)Have you ever been a foster parent in the past? (Applicant 2)YesNoWhich agency? (Applicant 2)Why did you close your license? (Applicant 2)Do you have any pending charges of a violation of law other than a minor traffic violation? (Applicant 2)YesNoHave you ever been convicted of a violation of law other than a minor traffic violation? (Applicant 2)YesNoHave you ever been investigated or have you had an open CPS case? (Applicant 2)YesNoPlease explain (Applicant 2):Family/HomeStreet Address *City *State *Zip *Family Income Level *$10,000-$19,999$20,000-$29,999$30,000-$39,999$40,000-$49,999$50,000+Persons currently living in your home including all adults and children:Person 1 NamePerson 1 BirthdatePerson 1 GenderPerson 1 RelationshipPerson 2 NamePerson 2 BirthdatePerson 2 GenderPerson 2 RelationshipPerson 3 NamePerson 3 BirthdatePerson 3 GenderPerson 3 RelationshipPerson 4 NamePerson 4 BirthdatePerson 4 GenderPerson 4 RelationshipIf you need more space, use this field to continue listing persons currently living in your homeSomeone in my household is able to speak a language other than English. Type the name of the language in the field below.ReferencesPlease list five (5) references that have known your family for at least two (2) years and are aware of your parenting skills (at least three (3) being non-relatives)Reference 1 Name *Reference 1 Address *Reference 1 Phone Number *Reference 2 Name *Reference 2 Address *Reference 2 Phone Number *Reference 3 Name *Reference 3 Address *Reference 3 Phone Number *Reference 4 Name *Reference 4 Address *Reference 4 Phone Number *Reference 5 Name *Reference 5 Address *Reference 5 Phone Number *Submit
