Online Inquiry

Click the 'Generate Form' link to pre-populate the form when you are ready.

<ul class="er_fld_row"><li class="er_fld_type_content" draggable="false">
<i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content">Thank you for your interest in applying with TxGBR. Please fill out all of the boxes and let us knowif you have any questions! </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false"><i class="fa fa-caret-down"></i><label class="er_fld_label">Interest in </label><select name="CST_1"><option value="Foster Care Only">Foster Care Only</option><option value="Foster to Adopt">Foster to Adopt</option><option value="Adoption Only">Adoption Only</option><option value="Kinship Placement">Kinship Placement</option><option value="Undecided">Undecided</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false">
<i class="fa fa-font"></i><label class="er_fld_label">How did you hear about us? </label><input name="CST_2" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Applicant One</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_A">
<i class="fa fa-font"></i><label class="er_fld_label">First Name </label><input name="CST_4" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Middle_A">
<i class="fa fa-font"></i><label class="er_fld_label">Middle Name</label><input name="CST_5" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Last_A">
<i class="fa fa-font"></i><label class="er_fld_label">Last Name </label><input name="CST_6" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Address Including City State and Zip </label><textarea name="CST_9" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Phone_Mobile">
<i class="fa fa-font"></i><label class="er_fld_label">Cell Phone </label><input name="CST_10" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_EMail">
<i class="fa fa-font"></i><label class="er_fld_label">E-Mail Address</label><input name="CST_30" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Are you over 21</label>
<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_8" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_8" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_8" value="Other:">Other:<input class="cst_Other" name="CST_8_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label">Country of citizenship:</label><input name="CST_28" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Highest Level of Education</label>
<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="GED">GED</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="High School ">High School </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Bachelors ">Bachelors </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Masters ">Masters </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Doctorate ">Doctorate </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Other:">Other:</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_11" value="Other:">Other:<input class="cst_Other" name="CST_11_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Employer_A">
<i class="fa fa-font"></i><label class="er_fld_label">Employer</label><input name="CST_12" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Occupation_A">
<i class="fa fa-font"></i><label class="er_fld_label">Job Title</label><input name="CST_13" type="text"></li><li class="er_fld_type_checkbox" style="white-space: normal; width: 25%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label"></label>
<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_14" value="Full Time">Full Time</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_14" value="Part Time ">Part Time </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_14" value="Other:">Other:<input class="cst_Other" name="CST_14_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">List other cities in Texas where you have lived in the past 5 years:</label><input name="CST_15" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">List all other names you have gone by:</label><input name="CST_16" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you ever been arrested/charged/convicted of a crime?</label>
<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Yes ">Yes </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_17" value="Other:">Other:<input class="cst_Other" name="CST_17_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_17" er_fld_condvals="er_fld_showif_values=Yes+" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, give details including date, location, and nature of the offense and disposition for each such incident.</label><textarea name="CST_18" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you ever been or are you currently being investigated for allegedly abusing, neglecting, or exploiting a child, an elderly person, or a person with disabilities?</label>
<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_19" value="Other:">Other:<input class="cst_Other" name="CST_19_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_19" er_fld_condvals="er_fld_showif_values=Yes" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, give details, including the state and county in which each such investigation occurred.</label><textarea name="CST_20" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Applicant Two </label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_B">
<i class="fa fa-font"></i><label class="er_fld_label">First Name </label><input name="CST_21" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Middle_B">
<i class="fa fa-font"></i><label class="er_fld_label">Middle Name </label><input name="CST_22" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Last_B">
<i class="fa fa-font"></i><label class="er_fld_label">Last Name </label><input name="CST_23" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Address</label><textarea name="CST_24" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Phone_Mobile_B">
<i class="fa fa-font"></i><label class="er_fld_label">Cell Phone</label><input name="CST_25" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail_2">
<i class="fa fa-font"></i><label class="er_fld_label">E-Mail Address</label><input name="CST_29" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Are you over the age of 21:</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_26" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_26" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_26" value="Other:">Other:<input class="cst_Other" name="CST_26_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Birthplace_B">
<i class="fa fa-font"></i><label class="er_fld_label">Country of Citizenship</label><input name="CST_27" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Highest Level of Education </label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="GED">GED</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="High School ">High School </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="Bachelors ">Bachelors </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="Masters ">Masters </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="Doctorate ">Doctorate </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_31" value="Other:">Other:</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_31" value="Other:">Other:<input class="cst_Other" name="CST_31_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Employer_B">
<i class="fa fa-font"></i><label class="er_fld_label">Employer</label><input name="CST_32" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Occupation_B">
<i class="fa fa-font"></i><label class="er_fld_label">Job Title</label><input name="CST_33" type="text"></li><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label"></label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_81" value="Full Time">Full Time</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_81" value="Part TIme ">Part TIme </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_81" value="Other:">Other:<input class="cst_Other" name="CST_81_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">List other cities in Texas where you have lived:</label><input name="CST_34" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">List all other names you have gone by: (maiden name)</label><input name="CST_35" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you ever been arrested/charged/convicted of a crime?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_36" value="Yes ">Yes </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_36" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_36" value="Other:">Other:<input class="cst_Other" name="CST_36_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_36" er_fld_condvals="er_fld_showif_values=Yes+" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, give details including date, location, and nature of the offense and disposition for each such incident.</label><textarea name="CST_37" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you ever been or are you currently being investigated for allegedly abusing, neglecting, or exploiting a child, an elderly person, or a person with disabilities?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_38" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_38" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_38" value="Other:">Other:<input class="cst_Other" name="CST_38_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_38" er_fld_condvals="er_fld_showif_values=Yes" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, give details, including the state and county in which each such investigation occurred.</label><textarea name="CST_39" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Family Information </label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_date" draggable="false" style="width: 33.3333%;">
<i class="fa fa-calendar"></i><label class="er_fld_label">Date of Marriage:</label><input class="cst_datepicker" name="CST_40" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label">County You Were Married In </label><input name="CST_41" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Please list members of your household (include children, relatives, and any non- relatives living in your home full or part-time):</label><textarea name="CST_42" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Please list children living outside of the home (if applicable):</label><textarea name="CST_43" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Were any of your children adopted?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_44" value="Yes ">Yes </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_44" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_44" value="Other:">Other:<input class="cst_Other" name="CST_44_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" er_fld_condfld="CST_44" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">If yes, what agency:</label><input name="CST_45" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Do any of your children have any special needs and/or behavioral problems?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_46" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_46" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_46" value="Other:">Other:<input class="cst_Other" name="CST_46_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_46" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, please explain</label><textarea name="CST_47" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you applied to another agency to foster or adopt?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_48" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_48" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_48" value="Other:">Other:<input class="cst_Other" name="CST_48_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_48" er_fld_condvals="er_fld_showif_values=Yes" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, what agency and when?</label><textarea name="CST_49" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have you ever been licensed with another agency?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_51" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_51" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_51" value="Other:">Other:<input class="cst_Other" name="CST_51_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_51" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, what agency and when? Reason For Leaving?</label><textarea name="CST_52" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">Religious Preference:</label><input name="CST_53" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_selected" draggable="false" style="width: 50%;" map_to="FH_Church">
<i class="fa fa-font"></i><label class="er_fld_label">Name of Church Attended:</label><input name="CST_54" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Discuss recreational interests, hobbies, family activities, etc.:</label><textarea name="CST_55" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Have either of you lived outside the state of Texas within the last 5 years?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_56" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_56" value="No ">No </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_56" value="Other:">Other:<input class="cst_Other" name="CST_56_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_56" er_fld_condvals="er_fld_showif_values=Yes" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">If yes, please list previous address(es) within the last 5 years: Street Address: City/State/Zip</label><textarea name="CST_57" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false"><i class="fa fa-header"></i><label>DESCRIPTION OF HOME</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Do you</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_58" value="Rent">Rent</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_58" value="Own ">Own </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_58" value="Other:">Other:<input class="cst_Other" name="CST_58_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Type of living unit?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_59" value="House">House</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_59" value="Apartment ">Apartment </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_59" value="Mobile Home">Mobile Home</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_59" value="Other:">Other:<input class="cst_Other" name="CST_59_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Check all that apply to your home</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do you have a two-story home?">Do you have a two-story home?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="How many bedrooms do you have?">How many bedrooms do you have?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="How many bathrooms do you have?">How many bathrooms do you have?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do all of the windows in your home open?">Do all of the windows in your home open?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do you have a pool and/or hot tub?">Do you have a pool and/or hot tub?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do you have a trampoline?">Do you have a trampoline?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do you own guns?">Do you own guns?</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_60" value="Do you have a fireplace?">Do you have a fireplace?</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_60" value="Other:">Other:<input class="cst_Other" name="CST_60_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Describe where your foster or adopted child would sleep:</label><textarea name="CST_61" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Would your foster or adopted children be sharing a room with someone? Who?</label><textarea name="CST_62" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>CHILD TRANSPORTATION</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Can you or someone in the household take children to counseling sessions, doctor visits, school meetings, family visitation, etc.? (Family visits are usually once a week.)</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_63" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_63" value="No">No</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_63" value="Other:">Other:<input class="cst_Other" name="CST_63_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_number" draggable="false" style="width: 50%;">
<i class="fa fa-hashtag"></i><label class="er_fld_label">How many children can your vehicle safely transport with safety belts and/or car seats?</label><input name="CST_64" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>SERVICE CALL INFORMATION</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">We must request service call information from law enforcement for the foster/adoptive parents� addresses for the past two years. Please provide the addresses where you have lived for the past two years. Include address, city, state, and zip code.</label><textarea name="CST_65" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false"><i class="fa fa-header"></i><label>QUESTIONNAIRE</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Which of the following best describes your motivation to foster or adopt? You may check more than one:</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We feel that fostering/adopting to be a mission field.">We feel that fostering/adopting to be a mission field.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We have struggled with infertility.">We have struggled with infertility.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We have always talked about a desire to foster or adopt a child.">We have always talked about a desire to foster or adopt a child.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We want to make a difference in the life of a child.">We want to make a difference in the life of a child.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="Our church presented information about the need for foster and adoptive families.">Our church presented information about the need for foster and adoptive families.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We have friends who have fostered/adopted.">We have friends who have fostered/adopted.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We saw pictures of the children in the Heart Gallery and that prompted us to look at adoption.">We saw pictures of the children in the Heart Gallery and that prompted us to look at adoption.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We met a child (ren) in the foster care system.">We met a child (ren) in the foster care system.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="We met a child (ren) available for adoption.">We met a child (ren) available for adoption.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_66" value="Other:">Other:</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_66" value="Other:">Other:<input class="cst_Other" name="CST_66_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_showif" draggable="false" er_fld_condfld="CST_66" er_fld_condvals="er_fld_showif_values=Other%3A" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Other</label><textarea name="CST_67" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">What is your motivation for wanting to become a foster or adoptive parent?</label><textarea name="CST_68" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Which of the following describes how you feel about the type of child you would consider for placement (ex. Age, gender, ethnicity, etc.)?</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">Ages</label><input name="CST_70" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">Gender</label><input name="CST_71" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label">Ethnicity</label><input name="CST_72" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">How firm are you on those preferences?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Absolutely firm on preferences.">Absolutely firm on preferences.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Fairly firm on preferences.">Fairly firm on preferences.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Willing to be flexible with preferences if trained.">Willing to be flexible with preferences if trained.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Very flexible with preferences.">Very flexible with preferences.</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_73" value="Unsure of preferences">Unsure of preferences</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_73" value="Other:">Other:<input class="cst_Other" name="CST_73_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">How comfortable are you with unknowns regarding a child�s background, history, and potential undiagnosed medical and/or emotional problems?</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_74" value="Not at all comfortable">Not at all comfortable</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_74" value="Not very comfortable">Not very comfortable</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_74" value="Somewhat comfortable">Somewhat comfortable</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_74" value="Somewhat comfortable">Somewhat comfortable</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_74" value="Very comfortable">Very comfortable</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_74" value="Other:">Other:<input class="cst_Other" name="CST_74_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Generally speaking, describe the level of risk with which you are most comfortable:</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_75" value="No risk">No risk</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_75" value="Low risk">Low risk</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_75" value="Moderate risk">Moderate risk</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_75" value="Significant risk">Significant risk</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_75" value="Risks are not a concern as we are only interested in fostering children, not adopting.">Risks are not a concern as we are only interested in fostering children, not adopting.</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_75" value="Other:">Other:<input class="cst_Other" name="CST_75_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Describe some important characteristics needed to be a foster/adoptive parent.</label><textarea name="CST_76" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">What days and times are the most convenient for you to attend training?</label><textarea name="CST_77" style="width:100%;"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label">Please list 6 references ***Include a relative not living with you and at least two of the following: school personnel, a neighbor, Pastor/Preacher/Minister.***</label><textarea name="CST_78" style="width:100%;">Name
E:Mail
Phone
Relationship
How long have you known them?

Name
E:Mail
Phone
Relationship
How long have you known them?

Name
E:Mail
Phone
Relationship
How long have you known them?</textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_signature" draggable="false" style="width: 50%;">
<i class="fa fa-pencil"></i><label class="er_fld_label">A prospective foster or adoptive parent is required to undergo a background check and an FBI fingerprint check. The prospective parent must also have a background check through the Central Registry for Child Abuse or Neglect. Any person living in the home that is age 14 and older will also require these background checks. Background checks will be conducted under the criteria used by DFPS and the Human Resources Department of the Health and Human Services Commission. Having a criminal history does not automatically disqualify an applicant from becoming a foster or adoptive parent. However, there are some felony or misdemeanor convictions that may require a risk assessment, or they might completely bar a person from being licensed. I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for the process of determining eligibility. I understand that false or misleading information, misrepresentation, or omission of significant information requested on this application or another form utilized by TxGBR and completed by the applicants will be grounds to refuse approval for foster care or adoption and placement. We understand that TxGBR retains the right to terminate services with us at any time if TxGBR determines that we do not meet the requirements as defined in TxGBR policies and Minimum Standards.</label><div class="cst_signaturepad"></div><input name="CST_79" type="text"><button class="type_button" disabled="">Clear Signature</button></li></ul><ul class="er_fld_row"><li class="er_fld_type_signature" draggable="false" style="width: 50%;">
<i class="fa fa-pencil"></i><label class="er_fld_label">Signature</label><div class="cst_signaturepad"></div><input name="CST_80" type="text"><button class="type_button" disabled="">Clear Signature</button></li></ul>