A New Leaf Foster Care Licensing Intake

A New Leaf Foster Care Licensing Intake

Our goal is to ensure that fosterparents feel welcomed and supported at A New Leaf’s Foster Care Program. Diversity, equity,inclusion, and justice are crucial elements for reaching our full potential andbuilding a stronger community.
Will you be applying with a partner/spouse or alone?*

Partner/spouseAlone
How did you hear about us?*
If a friend told you about us, who?
Please enter the full name.
If you heard about us from social media, which website?
Please enter the name of a social media site.
If other, how?

Applicant #1
Applicant #1
Full Name*

First NameMiddle NameLast Name
Preferred Name (if applicable)
Preferred Pronouns (if applicable)*
Preferred Language*
Native Language*
Gender*
Date of Birth*

MonthDayYear
Date
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship Status*
**If you are filing as married or in a long term relationship, please ensure that you are applying with a Partner/Spouse**
If not married, current length of relationship with partner?*
Enter number of years.
Profession*
How many years have you lived in Arizona?*
States lived in last 5 years if not Arizona:*
Do you have a Level 1 Fingerprint Clearance Card?*

YesNo
If no, are you willing to obtain a Level 1 Fingerprint Clearance Card?*

YesNo
Have you ever been convicted of a crime or felony?*

YesNo
If yes, state the nature of the crime:*
Have you ever been arrested?*

YesNo
If yes, state the nature of the arrest:*

Applicant #2
Applicant #2
Full Name*

First NameMiddle NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
Preferred Name (if applicable)
Preferred Pronouns (if applicable)*
Preferred Language*
Native Language*
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Profession*

How many years have you lived in Arizona?*
States lived in last 5 years if not Arizona:*
Do you have a Level 1 Fingerprint Clearance Card?*

YesNo
If no, are you willing to obtain a Level 1 Fingerprint Clearance Card?*

YesNo
Have you ever been convicted of a crime or felony?*

YesNo
If yes, state the nature of the crime:*
Have you ever been arrested?*

YesNo
If yes, state the nature of the arrest:*

Training
Are you able to commit to a 5 week training?*

YesNo
What time do you prefer for the required Foster Parent College training?*

Transportation
Transportation Plans

Please answer these questions about your vehicles.
Please list any vehicles in your possession.*
Are you willing to provide/acquire legally required infant/child car seats or booster chairs?*

YesNo
Do you have any questions, comments, or concerns about the licensing process OR about A New Leaf Foster Care?*
Feel free to ask anything! There are no dumb questions here!
When is/are the best time(s) to contact you in regards to this questionnaire?*

During my work hoursAfter my work hoursBefore my work hoursOn the weekends
Take a moment to review your answers before submitting!

A member of our team will reach out to you soon for an intake interview, to review this questionnaire, and to go over the next steps.
**For A New Leaf Use Only**
What is your motivation for wanting to become licensed for foster care?
What is your biggest concern about fostering?
Is your job/lifestyle flexible enough to accommodate different appointments for your foster child?
Have you talked to the important people in your lives about wanting to foster?
Agency Concerns:
Getting to Know You

To be filled out with partner/spouse (if applicable)
How do you feel about interacting with all those involved with the foster child such as DCS, biological parents, the court system, attorneys, and case aides?*
How do you feel about supporting child visitation with biological parents and siblings?*
What family supports do you currently have? Can any of these supports provide care temporarily if needed?*
What are your plans for childcare while you are at work?*
What discipline techniques are used or will be used in the home?*
How would you support the cultural needs of a child of a different race, religion, or culture than your own?*
Are there any behavioral challenges or known histories that you would not be willing to accept with a placement?*
Age Range?*
Up to how many children are you willing to care for at a time?
This is not set in stone- this will give ANL an idea of what your license preferences may be.
If kinship, what are the details on placement?
If kinship, what is the DCS Case Manager's email address?
example@example.com

Work Schedule

	Start Time	End Time
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

***Any individual 18 years or older living in the household, will need to obtain a Level 1 fingerprint clearance card.****
Should be Empty:

A New Leaf Foster Care Licensing Intake

Applicant #1

If you are filing as married or in a long term relationship, please ensure that you are applying with a Partner/Spouse

Applicant #2

Licensing Questions

Home Details

If yes, once licensed, smoking is not permitted in vehicles. There should be a designated are for smoking in home.

Transportation Plans

Take a moment to review your answers before submitting!

For A New Leaf Use Only

Getting to Know You

*Any individual 18 years or older living in the household, will need to obtain a Level 1 fingerprint clearance card.**

A New Leaf Foster Care Licensing Intake

Applicant #1

**If you are filing as married or in a long term relationship, please ensure that you are applying with a Partner/Spouse**

Applicant #2

Licensing Questions

Home Details

***If yes, once licensed, smoking is not permitted in vehicles. There should be a designated are for smoking in home.***

Transportation Plans

Take a moment to review your answers before submitting!

**For A New Leaf Use Only**

Getting to Know You

***Any individual 18 years or older living in the household, will need to obtain a Level 1 fingerprint clearance card.****

If you are filing as married or in a long term relationship, please ensure that you are applying with a Partner/Spouse

If yes, once licensed, smoking is not permitted in vehicles. There should be a designated are for smoking in home.

For A New Leaf Use Only

*Any individual 18 years or older living in the household, will need to obtain a Level 1 fingerprint clearance card.**