House Parent Application

1

Adult Caregiver #1

Name Last First MI

Address Street City/State Zip

Phone: Home Work Cell_______________

SSN Date of Birth ____________

Occupation Employer Name

# of years of school completed _Diploma/Degree(s)

Adult Caregiver #2

Name Last First MI

Address Street City/State Zip

Phone: Home Work Cell_______________

SSN Date of Birth

Occupation Employer Name

# of years of school completed Diploma/Degree(s) __________

Foster Care Info

Licensing Agency_______________________ Licensing Worker___________________

Number of years licensed in MO______ Number of children licensed for ______

Types of children you are licensed for: Traditional Elevated Needs A Elevated Needs B

Medical Respite Emergency

Email completed form to info@drummfarm.org

House Parent Application

2

Have you been a foster parent in other states? Yes No If yes, where and for how long____________________________________

Additional Household Members Name DOB Age In the Relationship Home? Y / N Y / N Y / N Y / N Y / N ________________________ _________ ___ Y / N __________________

Problem Solving Scenario: Currently, there are 6 foster kids in your home and tonight you have parent/teacher conferences at school at 6pm and 7pm. Two of your kids are on the brink of failing multiple classes in junior high so your attendance at these student-led conferences will weigh heavily on their grade. Another one of your kids got sent home sick with the flu and needs to get to urgent care, and your sibling set of 2 has to leave for a 1-hour visit at 6:30pm. Unfortunately, your partner/spouse, (the other adult caregiver), has 2 tickets to the Chiefs playoffs game tonight and is taking your oldest honor roll student to the game as a long awaited reward and will be unavailable to assist you. What will you do to assure everyone’s safety and well-being, and still get these vital tasks completed? Explain below (or attach an additional document).

House Parent Application

3

What motivated you to become a foster parent? If you currently foster children, what motivates you to continue to be a foster family? Explain below (or attach an additional document).

What about living at Drumm Farm Center for Children is appealing to you? What benefits do you think would come from living in a neighborhood of foster families? Explain below (or attach an additional document).

House Parent Application

4

Foster Community References:

List the names of three people that you have interacted with throughout your foster care journey that can speak to your skills and strengths as a foster parent.

1. Name Last First Address Street City/State Zip Phone: Work___________Cell_____________ Email address_________________ Employer _______________________ Occupation Relationship to you (ie: case manager, therapist, OGAL, CASA, etc) 2. Name Last First Address Street City/State Zip Phone: Work___________Cell_____________ Email address_________________ Employer _______________________ Occupation Relationship to you (ie: case manager, therapist, OGAL, CASA, etc) 3. Name Last First Address Street City/State Zip Phone: Work___________Cell_____________ Email address_________________ Employer _______________________ Occupation Relationship to you (ie: case manager, therapist, OGAL, CASA, etc)