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Treatment Foster Parent Inquiry

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Treatment Foster Parent Inquiry Form

Please fill out the form below to apply to become a Treatment Foster Parent.
All fields marked with a “*” are required.
Applicants must be at least 21 years of age and a resident of New Jersey with a valid drivers license.

General Information

Name *

First

Last

Total adults in the household? *

Total youth under 18 in the household: *

Are you at least 21 years of age? *

Yes
No

Do you have a valid New Jersey Driver’s License? *

Yes
No

Address

Address *

How many bedrooms are in your home? *

Contact Information

Home Phone

Cell Phone *

Email Address *

Preferences

I am interested in fostering: *

Yes
No

Please check all that apply.

Ages *

0-5
5-10
10-12
13+

Please check all that apply.

Why do you want to become a treatment parent? *

Would you consider fostering a youth with behavioral or emotional issues? *

Yes
No

Do you have any prior experience being a foster parent? *

Yes
No

Briefly describe your previous experience. *

I can financially sustain my home with my present income: *

Yes
No

I understand that all adults household members will need to complete background checks *

Yes
No

Treatment Home Open Houses events begin promptly at 6:30pm to 8:00pm the third Wednesday of each month.

How did you learn about Crossroads Programs’ Treatment Homes? *

Internet Search (Google, etc.)
Social Media (Facebook, etc.)
Friend
Community Event
Crossroads Programs’ Treatment Parent
Other

Please Explain (Other) *

Name of Treatment Parent *

First

Last

Website

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Crossroads Programs

Empowering the youth who are homeless, abandoned, abused, or at-risk to lead healthy, productive lives.

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