Contact us using the form below and we’ll be in touch shortly. "*" indicates required fields Step 1 of 8 12% How did you hear about us?*-- Select One --Search EngineSocial MediaFriendTVOtherIf you heard about us from social media, which website? If a friend told you about us, who? If other, how? Will you be applying with a partner/spouse or single?* Partner/Spouse Single Applicant 1 InformationApplicant 1 Full Name* First (Required) Middle (Required) Last (Required) Gender*-- Select One --MaleFemaleNon-binaryOtherPrefer not to sayDate of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address* Phone Number*Address* Street Address (Required) Address Line 2 (Required) City (Required) 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 / Province (Required) ZIP / Postal Code (Required) Relationship Status*-- Select One --MarriedIn a relationshipDivorcedWidowedLegally SeparatedSingleGo back to the top and select "Partner/Spouse" under "Will you be applying with a partner/spouse or alone?" Profession* How many years have you lived in Arizona?* Do you have a Level 1 Fingerprint Clearance Card?* Yes No If no, are you willing to obtain a Level 1 Fingerprint Clearance Card? Yes No Have you ever been convicted of a crime or felony?* Yes No Have you ever been arrested?* Yes No Applicant 2 InformationApplicant 2 Full Name First (Required) Middle (Required) Last (Required) Gender-- Select One --MaleFemaleNon-binaryOtherPrefer not to sayDate of birthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email Address Phone NumberAddress Street Address Address Line 2 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 Relationship Status-- Select One --MarriedIn a relationshipDivorcedWidowedLegally SeparatedSingleGo back to the top and select "Partner/Spouse" under "Will you be applying with a partner/spouse or alone?" Profession How many years have you lived in Arizona? Do you have a Level 1 Fingerprint Clearance Card? Yes No If no, are you willing to obtain a Level 1 Fingerprint Clearance Card? Yes No Have you ever been convicted of a crime or felony? Yes No Have you ever been arrested? Yes No Licensing Questions To be filled out with partner/spouse (if applicable)What type of care are you looking to provide?* Family Foster Home (FFH) Foster to Adopt Adoption Only Kinship Respite Select AllUp to how many children are you willing to care for at a time? How young of a child would you care for?*-- Select One --Newborn1234567891011121314151617How old of a child would you care for?*-- Select One --1234567891011121314151617Have you ever been denied licensure or had license revoked?* Yes No Have you ever been previously licensed for foster care?* Yes No Have you ever had any DCS investigations?* Yes No 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?*Would you be able to support the cultural needs of a child a child of a different race, religion, or culture?*Are there any behavioral challenges or known histories that you would not be willing to accept with a placement?*Are you able to commit to a 5 week training?* Yes No What time do you prefer for the required Foster Parent College training?*-- Select One --Weeknights 6pm - 9pmSaturday Morning 9am - 12pm Home Details Please answer these questions about your home where the child will be placed.How many people are currently living or will be living in the home, not including applicants or kinship children?*-- Select One --0123456 or more Home Details Please answer these questions about your home where the child will be placed.1st Person's Name First Last 1st Person's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201st Person's Gender-- Select One --MaleFemaleNon-binaryPrefer not to sayOther1st Person's Relationship-- Select One --GrandparentParentSiblingBiological ChildOther RelativeRoommateOtherDoes Person 1 Have Immunizations? Yes No 2nd Person's Name First Last 2nd Person's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119202nd Person's Gender-- Select One --MaleFemaleNon-binaryPrefer not to sayOther2nd Person's Relationship-- Select One --GrandparentParentSiblingBiological ChildOther RelativeRoommateOtherDoes Person 2 Have Immunizations? Yes No 3rd Person's Name First Last 3rd Person's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119203rd Person's Gender-- Select One --MaleFemaleNon-binaryPrefer not to sayOther3rd Person's Relationship-- Select One --GrandparentParentSiblingBiological ChildOther RelativeRoommateOtherDoes Person 3 Have Immunizations? Yes No 4th Person's Name First Last 4th Person's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119204th Person's Gender-- Select One --MaleFemaleNon-binaryPrefer not to sayOther4th Person's Relationship-- Select One --GrandparentParentSiblingBiological ChildOther RelativeRoommateOtherDoes Person 4 Have Immunizations? Yes No 5th Person's Name First Last 5th Person's Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119205th Person's Gender-- Select One --MaleFemaleNon-binaryPrefer not to sayOther5th Person's Relationship-- Select One --GrandparentParentSiblingBiological ChildOther RelativeRoommateOtherDoes Person 5 Have Immunizations? Yes No Remaining people currently living or will be living in the home, not including applicants or kinship children?What type of home do you have?* Single Family Apartment/Condominium Mobile Home Number of Bedrooms* Number of Bathrooms* Is there a pool or body of water?* Yes No Any plans to move in the next year?* Yes No Do you have any pets?* Yes No How many pets do you have? Do you own any weapons/firearms?* Yes No Do you smoke/use tobacco?* Yes No Do you or anyone in the home have a medical marijuana card?* Yes No Any individual 18 years or older living in the household, will need to obtain a Level 1 fingerprint clearance card. Home Details 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?* Yes No Final Questions Please answer these final questions and 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. Do you have any questions, comments, or concerns about the licensing process OR about RISE Arizona Foster Care?When is/are the best time(s) to contact you in regards to this questionnaire? Daytime Evening Weekends CAPTCHA Δ
