Child Foster Care Family Placement Application & Home Assessment Form
Primary Applicant Full Name
· · ·
Email Address
· · ·
Phone Number
· · ·
Submit
The Child Foster Care Family Placement Application & Home Assessment Form is a comprehensive tool designed to help child welfare agencies, nonprofits, and social services organizations efficiently collect and evaluate information from prospective foster families. It captures primary and co-applicant personal details, household composition, employment background, criminal history disclosures, and prior fostering or adoption experience.
This form is ideal for licensed foster care agencies and social workers who need a structured, standardized way to screen and assess potential foster parents. By gathering details about preferred age groups and the types of children applicants are willing to foster, it helps match children with the most suitable family environments quickly and accurately.
Using this ready-to-use template saves agencies significant time compared to building forms from scratch, ensures no critical information is missed, and creates a professional, trustworthy experience for applicants. Customize it to match your organization's specific requirements and start receiving complete, well-organized applications today.
4Pages
33Questions
~11minTo complete
FreeNo credit card needed
Field types
Yes / No ×7
Long Text ×6
Short Text ×3
Full Name ×2
Date ×2
Single Choice ×2
number ×2
Multiple Choice ×2
Email
Phone
Address
currency
File Upload
termsandconditions
Signature
Questions in this template
Free template
The exact questions included — customize any of them to fit your needs.
Page 1Applicant Information9 questions
Primary Applicant Details
1
Primary Applicant Full Name
*Full Name
2
Email Address
*Email
3
Phone Number
*Phone
4
Date of Birth
*Date
5
Current Residential Address
*Address
6
Marital Status
*Single Choice
7
Co-Applicant / Spouse Full Name
Full Name
8
How many people currently live in your household?
*number
9
Please list all household members, their ages, and relationship to you
*Long Text
Page 2Background & Qualifications8 questions
Employment, Background & Experience
1
Current Employer / Occupation
*Short Text
2
Combined Annual Household Income
*currency
3
Have you ever been convicted of a criminal offense?
*Yes / No
4
If yes, please provide details including dates and outcomes
Long Text
5
Have you previously fostered or adopted a child?
*Yes / No
6
If yes, please describe your previous fostering or adoption experience
Long Text
7
What age group(s) are you willing to foster?
*Multiple Choice
8
Are you open to fostering children with any of the following?
*Multiple Choice
4
Will the foster child have their own bedroom?
*Yes / No
5
Do you have a fenced yard or safe outdoor play area?
*Yes / No
6
Are all firearms, medications, and hazardous materials securely locked and stored?
*Yes / No
7
Do you have working smoke detectors and fire extinguishers in the home?
*Yes / No
8
Please describe any pets in the household, including breed and temperament
Long Text
Page 4References, Motivation & Consent8 questions
Personal References
Please provide two non-family personal references who can speak to your character and suitability as a foster parent.
1
Reference 1 — Full Name, Phone Number, and Relationship
*Short Text
2
Reference 2 — Full Name, Phone Number, and Relationship
*Short Text
Motivation & Additional Information
3
Why do you want to become a foster parent? Please describe your motivation and what you hope to provide a child in your care.
*Long Text
4
Is there any additional information you would like the placement agency to know?
Long Text
5
Upload supporting documents (e.g., proof of income, home insurance, background check clearance)
File Upload
6
I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that falsification of any information may result in denial of my application. I consent to background checks, home inspections, and reference verification as part of the assessment process.
*termsandconditions
7
Applicant Signature
*Signature
8
Date of Signature
*Date
How to use this template
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