Colbren Family Care
Foster Parent Application Forms
· Foster Parent Initial Application Form-
The Colbren Family care initial application information/form is the first packet we will send to you to get started. This packet is important in order to obtain your contact information, family info, and what your experience and preferences as a foster parent are. Normally, we will send out the rest of the information listed below once you have completed and submitted this form back to us.Click here to download the application form.
· Rule 501-12 Child Foster Care Packet-
This Packet is extremely important as it defines the basic
core rules, policies & procedures, and requirements for foster parents set
by the State of
· Foster and Proctor Parent Requirements-
This checklist accompanies the Rule 501-12 packet. Upon reading the packet, you are required to initial that you have read and agree to each section of the code and the procedures described therein. If married, both you and your spouse must read the packet and complete the checklist.Click here to download the 501-12 requirements checklist.
· Request for Taxpayer Identification – W-9 Form-
As a foster parent, you are not an employee of Colbren Family Care; therefore, we will not deduct taxes from your monthly payment. You are licensed and subcontracted as a professional foster parent. For this reason, Colbren Family Care is required to have on file a W-9 form for auditing reasons. The parent who we will make the payment checks payable to will complete this form. Once completed, please return the form to us.Click here to download the W-9 form.
· Employment Eligibility Forms(s)-
Although as a foster parent you are not an employee, Colbren
Family Care as a licensing agency is required by the U.S. Department of Justice
to verify that you are legally entitled to work inside the
· Background Screening Application(s)-
Please read the instructions on this form carefully. All potential foster parents must submit
to a background check and finger printing.
This is done per-company, so even if you have submitted a background
screening recently, we would still need to submit one for you specific to being
a foster parent for Colbren Family Care.
Electronic finger printing will be conducted at DCFS offices on
For additional information regarding the backgrond screening application or licesing, please refer to the DHS Office of Licensing website.
· Cohabitation Declaration/Signature(s)-
· Medical Statement(s) for Foster/Proctor Care Applicant(s)-
We are required to obtain a signed statement from you and a licensed health care professional who is aware of your physical well-being. This is required in order to attest that you and your spouse are physically capable of being foster parents. This form comes in two parts: one side of the page you will complete yourself, the other side will need to be completed by your clinician. Once completed, he/she will send the form directly to us by mail (we have provided a self stamped envelope for this).Click here to download the medical form.
· Letters of Reference/Recommendation-
Finally, we are required to obtain from you 3 - 4 letters of reference for your family. Please remember, only one letter can be from someone related to you. The others can be from friends, co-workers, supervisors, or other people who are generally aware of how you, your spouse, and your other family members behave around other people (children in particular). Remember, these letters of reference must be submitted by them directly to us by standard mail, fax, or e-mail. This form can be downloaded at: www.colbren.com/reference_letter.doc To save postage, they are welcome to send the reference letter as an attachment to: firstname.lastname@example.orgClick here to download the reference letter form.
For your own records, please make copies of all completed forms and documents before submitting them to us.
Once you have completed a form, please send it by mail to PO Box 461077,
Always remember, if you have any doubts, questions, or concerns at all, please feel free to call us:
Forrest DeMille, Vice President & Program Director; (435) 705-1833
Brent DeMille, President & Clinical Director; (435) 632-4407