Pre-Application Form Human Services ConsultantsPre-Application Questionnaire Please complete this form with your current information and click on Submit. Last Name: Date: General Information Applicant Spouse Marital Status MarriedDivorcedSingleWidowed Home Address Mailing Address (if different) Street Address City Zip Code County Directions to your housefrom major road: Contact Information Home Phone Applicant Spouse Cell Phone E-mail List all of the members in your home: Name Gender Date of Birth Relationship to Applicant Home Information Number of Bedrooms 234567 Bedroom for Foster Child 123 Pool YesNo Pool Fence YesNo Pets DogCatOther Experience Applicant Spouse # of Years # of Years HCTCRegular Foster CareWorking with Children HCTCRegular Foster CareWorking with Children Please list any previous foster care experience: Please list any previous experience working with children: Has anyone in your home been arrested? YesNo If yes, please explain: Do you or anyone in your home have any health issues? YesNo If yes, please explain: Do you or anyone in your home have any mental health issues? YesNo If yes, please explain: Please explain your motivation for becoming a foster parent: Referred by: Information Source: Note: Input this code: To use CAPTCHA, you need Really Simple CAPTCHA plugin installed.