St. Jerome Emiliani – Foster Care Parent Questionnaire

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's Foster Family Screening Questionnaire

Personal Information

Address *
Address
City
State/Province
Zip/Postal
Country
Gender: *

Home Relationship

Please describe your relationship status: *
Spouse's Gender:
Have you ever been previously divorced? *
If married, has your spouse ever been previously divorced? *

Stability

Have you, or anyone in the home, previously been charged with or been convicted of a crime? If so, please describe the circumstances. *
Have you, or has anyone in your home, been arrested? If so, please describe the circumstances. *
Have you, or has anyone in your home, been the subject of a report of child abuse? If so, please describe the circumstances. *
Are you financially self-sufficient, that is, do you rely solely on your own income for all necessities? *
Have you ever been subject to foreclosure proceedings? *
Have you ever filed for bankruptcy? *
Do you expect to retain your current employment for the foreseeable future? *
Have you ever filed for a protection order? *
Has a protection order ever been filed against you? *
Do you plan on moving in the near future? *
Have you ever received counseling/treatment/medication for mental health or substance abuse? If so, please describe. *

Foster Openness

Are there children you would not be willing to foster (if yes, please describe)? *
Would you accept siblings? *
Are you willing to foster children that you would not be planning to adopt? *

Choice of Agency

Have you contacted any other foster agencies about becoming a foster parent (if yes, please list which agencies you have been in contact with)? *
Please select the orientation date and time you'd like to register for:
Our program works with foster parents who are local to our area. Do you reside in the Greater Galveston-Houston region?
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