A New Leaf Foster Care Licensing Intake
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  • 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?*
    • Applicant #1 

    • Applicant #1

    • Date of Birth*
       / /
    • Format: (000) 000-0000.

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

    • Do you have a Level 1 Fingerprint Clearance Card?*
    • If no, are you willing to obtain a Level 1 Fingerprint Clearance Card?*
    • Have you ever been convicted of a crime or felony?*
    • Have you ever been arrested?*
    • Applicant #2 

    • Applicant #2

    • Date of Birth*
       / /
    • Format: (000) 000-0000.
    • Rows
    • Do you have a Level 1 Fingerprint Clearance Card?*
    • If no, are you willing to obtain a Level 1 Fingerprint Clearance Card?*
    • Have you ever been convicted of a crime or felony?*
    • Have you ever been arrested?*
    • Licensing Questions 

    • Licensing Questions

      To be filled out with partner/spouse (if applicable)
    • What type of care are you looking to provide?*
    • Format: (000) 000-0000.
    • Have you ever been previously licensed for foster care?*

    • If yes, what agency:         
      What state:

    • Have you ever been denied licensure or had license revoked?*
    • Have you ever had any DCS investigations?*
    • Training 
    • Are you able to commit to a 5 week training?*
    • Home Details 

    • Home Details

      Please answer these questions about your home where the child will be placed.
    • What type of home do you have?*
    • Is there a pool or body of water?*
    • If yes, is it fenced in?*
    • If no, would you be willing to fence it? (If not, you can only be licensed for children ages 7+)*
    • Any plans to move in the next year?*
    • Do you own any weapons/firearms?*
    • If yes, are you willing to follow DCS required safeguards?*
    • Do you smoke/use tobacco?*

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

    • Transportation 

    • Transportation Plans

      Please answer these questions about your vehicles.
    • Are you willing to provide/acquire legally required infant/child car seats or booster chairs?*
    • When is/are the best time(s) to contact you in regards to this questionnaire?*

    • 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**

    • Getting to Know You

      To be filled out with partner/spouse (if applicable)
    • Rows

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

    • Should be Empty: