Foster Home Services Our ProgramsFoster Care Family Foster Care/Kinship Family Foster Care: ChildSuccessNYC Medically Fragile Foster Care Treatment Family Foster Care Unaccompanied Minors Program Becoming a Foster Parent Residential Care Behavioral Health and Wellness LEAP Family Support Programs for Sexually Abused Children Services in the Jewish Community Home » Foster Parent Inquiry Form Foster Parent Inquiry Form Applicant InformationName* First Last Gender*MFPrefer Not To SayDate of Birth* Email* Cell Phone*Home PhoneBest time to call*Choose OneAMPMAnytimeOtherPlease Specify* Address* Street Address Apt # City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a co-applicant?* Yes No Co-Applicant Name* Relationship to Applicant* Cell Phone*Home PhoneEmail How did you hear about JCCA(Please check all that apply) JCCA Employee Recruitment Event Current Foster Parent Previous Foster Parent Other Please Specify* Home InformationWhat is the primary language spoken in your home?* English Spanish Creole Other Please Specify* Are there additional languages spoken in your home?* Yes No Please Specify* Have you been a foster parent previously?* Yes No If yes, what agency?* How many adults (18+) live in your home?* How many children live in your home?* How many bedrooms do you have?* Do you have any pets?* Yes No If yes, what kind of pet do you have?* What type of home do you reside in?*(Please select one) Private House Apartment What type of apartment do you reside in?*(Please select one) 1 or more bedrooms Studio apartment Railroad apartment (series of rooms connecting to each other in a line) PreferencesJCCA offers several types of foster home programs. To help us find the right fit for you, please choose from the options below.Are you interested in caring for young people with additional needs?(Please check all that apply) Youth with moderate to severe emotional & behavioral concerns Mother/child pairs Sibling groups Children with serious medical conditions Teens Unaccompanied minors Preferred Age Range of Foster Child:(Please check all that apply) 0 - 5 5 - 12 12 and up Any Age Preferred Gender:(Please check all that apply) Male Female Any Gender Please add any comments or questions for JCCA's Homefinding Staff: Our ProgramsFoster Care Family Foster Care/Kinship Family Foster Care: ChildSuccessNYC Medically Fragile Foster Care Treatment Family Foster Care Unaccompanied Minors Program Becoming a Foster Parent Residential Care Behavioral Health and Wellness LEAP Family Support Programs for Sexually Abused Children Services in the Jewish Community
