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Urgent Care & ER
Foster Care Fact Sheet:
Section 1 - Applicant 1 Information
Employment/Education - Applicant 1
Health - Applicant 1
Section 2 - Applicant 2 information
Employment/Education - Applicant 2
Health - Applicant 2
Section 3 - Relationship status
Section 4 - Household composition
Section 5 - Finances (All foster parents must be financially stable and able to support themselves and their families without relying on kinship, adoption or foster care payments. Please list all of your monthly income and household expenses. Verifications such as check stubs and/or tax returns and current bills are required.
Monthly expenses
Section 6
Section 7 - Confidential information (Please be aware that marking
Section 8 - References (Please provide three non-relative references (If applying for TFC or Respite, at least one must be a professional reference) and two relative references (including at least one adult child- if applicable), who can speak on behalf of Applicant 1 and 2.)
I understand that, to ensure the safety of foster children, Children's Service Society of Wisconsin may, for the purpose of licensing, obtain the following information: 1. Police and/or Other Criminal Records Checks DCF 56.05(1)(f)(2)(a) 2. Traffic Transcripts DCF 56.05(1)(f)(2)(a) 3. Employment Verification References DCF 56.05(2) 4. Character References DCF 56.13(4)(b),(5)(c)(6)(c) 5. Insurance Verifications DCF 56.04(4)(a)(2) 6. Service Report from the County Department of Social or Human Services DCF 56.05((1)(f)(2)(c) 7. Previous licensing information from the Bureau of Milwaukee Child Welfare, any public or private child welfare agency, any public or private child placing agency, any daycare licensing or group home licensing agency, if applicable. My signature below: 1. Grants Children’s Service Society permission to obtain specified information for the purpose of Foster Home Licensing; 2. Signifies my understanding that falsifying any of the information on this form may be grounds for revocation of my Foster Home License, should a license be issued.
FOR USE ONLY IF APPLICANT CANNOT FILL OUT FORM. I have reviewed all the items on the form with the applicant, and have marked the information as stated by the applicant. I have not altered anything.
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