New Caregiver Interest Foster/Respite Parent Interest Form Applicant Name * First Name Last Name Applicant Age Applicant Cell Number (###) ### #### Applicant Email * Co-Applicant Name First Name Last Name Co-Applicant Age Address Address 1 Address 2 City State/Province Zip/Postal Code Country Are you a resident of NM? Yes No Have you lived in NM for at least 5 years? Yes No Do you have a current driver's license? Yes No Do you have reliable transportation? Yes No Are you currently employed outside the home? Yes No If Yes, Where do you work and what is your job title: Are you married? Yes No How long have you and the Co-Applicant been together? Do you have children living in your home? Yes No If Yes - List their ages: Are there any other adults living in your home (other than applicant and co-applicant)? Yes No Do you understand that HDFS will do a criminal background check on each adult in the home? Yes No Do you own your home? Yes No Do you have pets? Yes No Do you smoke? Yes No Do you have a spare room? Yes No What ages of children are you interested in working with? What schools are in your District (Elementary, Middle, High)? Have you ever applied to High Desert before? Yes No Have you ever been a foster parent before? Yes No If yes, please check off which agency (check all that apply): CYFD Bair Foundation Hogares La Familia NM Solutions Open Skies Red Mountain Family Services Teambuilders Other If you are currently licensed with another agency, do you have a current placement? Yes No Are you currently certified in CPR and First Aid? Yes No What languages are spoken in the home: Please describe in detail why you want to become a treatment foster parent or respite provider. What qualities do you possess that would make you a good foster parent? Please answer this question completely and thoughtfully. How did you hear about our agency? Internet search Facebook Instagram Peachjar/School Event-Community Booth Current Foster/Respite Parent CYFD NM Child First Network Other Comment Thank you for submitting the form. We will contact you back soon.
