St. Jerome Emiliani – Foster Care Parent Questionnaire

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Thank you for your interest in becoming a foster care parent through Catholic Charities’ St. Jerome Emiliani Foster Care program. Please complete all fields below. A representative from Catholic Charities will get back with you as quickly as possible. For any specific questions, please contact SJEHCRecruitment@catholiccharities.org.

St. Jerome Emiliani – Foster Care Parent Questionnaire

"*" indicates required fields

1Personal Information

2Stability

3Home Relationship

4Foster Openness

5Choice of Agency

Our program works with foster parents who are local to our area. Do you reside in the Greater Galveston-Houston region?*

Yes

Name:*

First Name Last Name

Date of Application:*

MM slash DD slash YYYY

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender:*

Male

Female

Date of Birth:*

MM slash DD slash YYYY

Phone*

Email*

Please describe your relationship status:*

Single

Married

Other (please specify)

If married, please provide your spouse's name:*

Spouse's Date of Birth:*

MM slash DD slash YYYY

Spouse's Gender*

Male

Female

Are you currently living, even part time, with any romantic partner whom you are not married to?*

Yes

How many other people are living in the home (excluding you and your spouse)?*

Please list the name, date or birth, relationship to the applicant, occupation and sex of all other persons living in the home:*

Have you ever been previously divorced?*

Yes

If married, has your spouse ever been previously divorced?*

Yes

Have you, or anyone in the home, previously been charged with or been convicted of a crime? If so, please describe the circumstances.*

Yes

Please describe:*

Have you, or has anyone in your home, been arrested? If so, please describe the circumstances.*

Yes

Please describe:*

Have you, or has anyone in your home, been the subject of a report of child abuse? If so, please describe the circumstances.*

Yes

Please describe:*

Are you financially self-sufficient, that is, do you rely solely on your own income for all necessities?*

Yes

Approximate income:*

Have you ever been subject to foreclosure proceedings?*

Yes

Have you ever filed for bankruptcy?*

Yes

Do you expect to retain your current employment for the foreseeable future?*

Yes

Have you ever filed for a protection order?*

Yes

Has a protection order ever been filed against you?*

Yes

How long have you lived in the state of Texas?*

Do you plan on moving in the near future?*

Yes

Have you ever received counseling/treatment/medication for mental health or substance abuse? If so, please describe.*

Yes

Please describe:

How did you become interested in becoming a foster parent?*

What made you decide to become a foster parent?*

How long have you been interested in becoming a foster parent?*

Have you ever cared for foster children before?*

Yes

Are there children you would not be willing to foster (if yes, please describe)?*

Yes

Please describe:*

Would you accept siblings?*

Yes

Are you willing to foster children that you would not be planning to adopt?*

Yes

When would you like to start caring for children?*

How did you find out about Catholic Charities?*

Have you contacted any other foster agencies about becoming a foster parent (if yes, please list which agencies you have been in contact with)?*

Yes

Please list all agencies that you have been in contact with:*

Please select the orientation date and time you'd like to register for:*

March 13th (Wednesday at 6:00PM) Virtual Zoom

March 20th (Wednesday at 6:00PM) Virtual Zoom

March 27th (Wednesday at 6:00PM) Virtual Zoom

April 3rd (Wednesday at 6:00PM) Virtual Zoom

April 10th (Wednesday at 6:00PM) Virtual Zoom

April 17th (Wednesday at 6:00PM) Virtual Zoom

April 24th (Wednesday at 6:00PM) Virtual Zoom

May 1st (Wednesday at 6:00PM) Virtual Zoom

How did you hear about us?

BBB Winner of Distinction 2018 White Portrait

Contact Us



Houston - Catholic Charities of the Archdiocese of Galveston-Houston.

Address:

2900 Louisiana Street,
Houston,
Texas,
77006



Houston - Catholic Charities of the Archdiocese of Galveston-Houston.

Address:

2900 Louisiana Street,
Houston,
Texas,
77006

Phone: 713.526.4611

EIN: 74-1109733

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