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Foster Parenting Questionnaire

Thank you for your interest in foster parenting.

To help us assist you with the information you are seeking, please provide the information listed below.

First Name:

Last Name:

Address:

Address (cont.):

City, State, ZIP:

Phone:

Email Address:

School District:

County:

How would you like to be contacted?

EmailPhone

How did you hear about CONCERN?

If you selected "Search Engine" or "Other", please specify:

What ages would you accept into your home? (check all that apply)

0-6 years7-10 years11-12 years13-18/21 years

Gender of child(ren) you would accept into your home:

MaleFemale

What type of specialized "type of placement" you would consider? (check all that apply)

Foster-to-AdoptMedical Foster CareMother/BabySiblingsAdoptionCommunity Residential Rehabilitation

Other pertinent information you feel we should know:

Foster Parenting Informational Meeting

Informational meetings are held at each foster care service site.  Contact the site nearest you for more information on upcoming meetings.

CONCERN Office Locations

© 2019 CONCERN - Professional Services for Children, Youth, and Families

Corporate Office
One West Main Street, Fleetwood, PA 19522
(610) 944-0445

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