Therapeutic Foster Care Interest Form

First Name *

Last Name *

Street Address

Address Line 2

City *

State *

Zip Code

Phone Number *

Email Address *

How did you hear about the need for HCTC/Therapeutic Foster Care parents?

AzCA Website

Facebook

Print Ad

Other Other

Are you at least 25 years or older? *

Yes

No

How many children currently reside in your home? What are their ages? *

Have you been a foster parent before? *

Yes

No

Have you worked in a group home or treatment facility for children? *

Yes

No

Do you have other applicable experience? Briefly explain: *

List two behaviors that might be present with a child who has suffered trauma. *

Name two interventions that might be used to address the behaviors. *