NORFIL FOUNDATION INC.

# 16 Mother Ignacia St.

corner Roces Avenue Quezon City

Foster Care Application Form

Date:______

  1. Identifying Data:Husband Wife

Name______

Date of Birth______

Place of Birth ______

Date of Marriage______

Nationality ______

Citizenship______

Home Address______

Telephone No.______

Religion______

Highest Educational______

Attainment

Present Occupation/______

Employment

Business Address______

Telephone No. ______

Salary (monthly)______

Other income if any______

Hobbies/Interests______

  1. Family Composition (list all individuals living with the family)

Name / Relation / Age / Sex / Educational Attainment / Occupation
  1. Reason (s) for wanting to become licensed foster parents.

___Interest in caring for a non-related child particularly unfortunate children

___Companionship

___Playmate for other children

___Share one’s resources

___Share Love

___Others, pls. specify ______

______

______

  1. CHILD PREFERENCE
  2. Check which of the following types of foster child/ren your family can foster

No. of Children you

can foster at any

given time.SexAge RangeCharacteristics

__ 1__ Male__ 0-2__ Healthy

__ 2__ Female__ 3-5__ Sibling group

__ 3__ Either__ 6-9 __ With minor physical __ 10-12 handicap __ 13-15 __ With mild developmental __ 16 and delay

Above__ Others specify ______

4.2 Reason (s) for Child Preference______

______

  1. Experience in caring for children:

___ Yes. Indicate relationship with child by checking appropriate space.

__ Own Child

__ Nephews/Nieces

__ Others, pls. specify ______

__ No.

  1. Check which of the following types of foster care your family can provide.

__ Short term(6 months or less)

__ Long term(6 months or more)

  1. Indicate alternative care arrangement for the foster child, if for some reasons you cannot personally attend to the needs of the child.

__ Relative (i.e. grandmother, aunt, cousin)

__ Own children

__ Yaya/Maid

__ Others, pls. specify ______

  1. Attendance in foster care session.

__ Yes, pls. indicate most convenient date and time.

__ No

  1. Willingness to work with and be visited periodically by social worker.

__ Yes

__ No

  1. Please give three (3) character references: (Indicate name, address & telephone number)
  1. ______
  2. ______
  3. ______

______

Foster Father-Applicant Foster Mother-Applicant

Note: NORFIL Foundation – (02) 3723577loc. 30