Foster Care & Adoption Initial Assessment

(If adoption only and want under age 8 refer to 1-800-96ADOPT)
How did you hear about the program? *
 TV CommercialRadioBillboardFacebookWebsiteAll Pro Dads
How did you hear about the program continued....
 Pick at least one
Church (Name of church and Denomination)
Foster Parent/Friend (Name of Person)
Recruitment Event (Event name/location)
Child Specific (Child's Name)
Referral Source: (ICPC, OTI, CMO)
If yes:
 you must have at least one item
What was the name of the Agency you were previously licensed with?
Do you have a contact name and number for the agency?
Did you close your home voluntarily or did the agency recommend you home be closed?
If agency recommended closer what was the reason?