Foster Family Application

I. Family Information

Print all information. Please fill out each section in its entirety, accurate information is essential to the application process.








Telephone Number(s)



Date of Birth


Race/Gender


Religion/Affiliation


US Citizen?


Driver License Number


Language(s)


Marital Status (include date)


Previous Marriage (Date, City, State)


Date Terminated (specify death, divorce, etc.)


Military Service (include branch, dates)


Last Grade Completed


Occupation


Employer


Annual Income


Work Phone Number


Emergency Name and Phone Number





Children in the Home

















Children Out of the Home

















Others in the Home

















II. Legal

Please answer the following questions concerning previous or current legal issues. If a question is answered as “yes” please provide information regarding the issue as well as formal documentation. No applicant may be approved who has a FELONY CONVICTION involving child abuse or neglect, spousal abuse, a crime against a child or children (including child pornography) or a crime involving violence including rape, sexual assault, or homicide, but not including other physical assault or battery. No applicant may be approved who has a FELONY CONVICTION in the past five (5) years involving physical assault, battery, or a drug/alcohol related offense.

Are you currently charged with, or have you even been convicted, placed on probation or received a suspended sentence for:

Any crime involving children?

Applicant YesNo
Co-applicant YesNo


Any crime of violence against another person?

Applicant YesNo
Co-applicant YesNo


Possession, sale, manufacturing or transportation of drugs?

Applicant YesNo
Co-applicant YesNo


Any other crime?

Applicant YesNo
Co-applicant YesNo


If yes, please explain


Have you had previous involvement with Child Protective Services?

Applicant YesNo
Co-applicant YesNo


Have you had previous involvement with Adult Protective Services?

Applicant YesNo
Co-applicant YesNo


Have you had previous involvement with Department of Children’s Services?

Applicant YesNo
Co-applicant YesNo


If yes, please describe in detail and give time and place.

If yes, please list date(s), agency, and amount of experience

Do you currently have a foster child in your home at this time? YesNo

Former Addresses

Please list your addresses for the past 10 years. Information MUST include dates lived at former addresses.





































Work Experience

Please list work experience for each applicant.

Applicant









Applicant









Applicant









Co-Applicant









Co-Applicant









Co-Applicant









V. Foster Parent Reference Information

Applicant Relative









Co-applicant Relative









Friend









Friend









Friend









VI. Monthly Family Income and Expenditures

Please complete this section in its entirety. Monthly income MUST cover monthly expenditures. All foster parents are required to have an income sufficient to meet the financial needs of the family.

Occupation


Employer


Years in Current Position


Monthly Income/Pay


Additional Monthly Income


Total Individual Income



Financial Resources


Other Financial Resources









Monthly Expenditures

Home


Utilities





Insurance




Installment Payments for:




Additional Expenses








VII. HOME/SAFETY INFORMATION

Please answer the following questions to the best of your ability.

Do you own your own home? YesNo

What type of housing do you reside in? Single FamilyMulti FamilyApartmentCondo/TownhousePublic/Sec. 8 HousingMobile Home





Are there weapons in the home? (i.e.- guns, hunting knives, display knives, bows/arrows, etc.)
YesNo


Do you have a pool, spa, or hot tub on the property? YesNo
If yes, are all county/city codes met? YesNo
Is there a locked fence surrounding the pool, spa, or hot tub? YesNo


Do you have pets? YesNo

If yes, please list them below:











VIII. TYPE OF CHILD YOU HOPE TO FOSTER

Please answer the following questions to the best of your ability at this time. Free Will Baptist Family Ministries understands the gender/age of the child you hope to foster may change during the preparation process. As a foster parent you are encouraged to update this information as you continue to redefine the child you wish to parent.

Gender MaleFemaleEither

Sibling Group YesNo


Would you consider fostering a child from a racial, cultural, ethnic background other than yours? YesNo


Type of care you wish to provide (Please select all the may apply to your family): FosterAdoptKinshipRespite

IX. Signatures

By my signature below, I hereby certify that the information contained in this application is, to the best of my knowledge, true and accurately represents my background and experience. I also verify that there is nothing in my background that would constitute a health and/or medical risk to children. I understand that failure to give complete information or falsification or misrepresentation of information may prohibit my family from working with Free Will Baptist Family Ministries and if discovered after licensing, will be grounds for revocation of my license as a foster parent.



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Contact Us

90 Stanley Lane
Greeneville, TN 37743
(423) 639-9449 (main office)
(423) 639-5083 (fax)

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Testimony

We are very thankful to God for the ministry of FWB Family Ministries. Ruth and I met while living at the Children's Home in the 70's. We were engaged there and later married at Harris Memorial FWB Church near the campus. Our wedding was performed by Rev. James Earl Raper, the Superintendent at the time we lived there. We just celebrated our 30th wedding anniversary on August 6, 2012. God is so good. We became Christians there and began our life as a couple there, Thank you FWBFM.
Ivan & Ruth (Turner) Kennedy, Talbott, TN

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Photo Album

A happy foster family