Online Inquiry
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<ul class="er_fld_row"><li class="er_fld_type_content er_fld_selected" draggable="false"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content">We would love to talk to you about foster care and adoption through Texas Girls and Boys Ranch. Please fill this out and someone will be in contact with you soon. - Erin and Emily Eolmos@txgbr.org Eschramm@txgbr.org</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 required">Interest in </label><select name="CST_1" class="er_fld_required"><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 required">How did you hear about us? </label><input name="CST_2" type="text" class="er_fld_required"></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 required">First Name </label><input name="CST_4" type="text" class="er_fld_required"></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 required">Last Name </label><input name="CST_6" type="text" class="er_fld_required"></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 required">Address Including City State and Zip </label><textarea name="CST_9" style="width:100%;" class="er_fld_required"></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 required">Cell Phone </label><input name="CST_10" type="text" class="er_fld_required"></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 required">E-Mail Address</label><input name="CST_30" type="text" class="er_fld_required"></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 required">Are you over 21</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_8" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" 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 er_fld_required" type="checkbox" name="CST_8" value="Other:">Other:<input class="cst_Other er_fld_required" 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_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_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: 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 if applicable:</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" 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_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_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 required">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 er_fld_required" type="checkbox" name="CST_63" value="Yes">Yes</label><label class="er_option"><input class="type_checkbox er_fld_required" 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 er_fld_required" type="checkbox" name="CST_63" value="Other:">Other:<input class="cst_Other er_fld_required" 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_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_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;"> <i class="fa fa-paragraph"></i><label class="er_fld_label required">What is your motivation for wanting to become a foster or adoptive parent?</label><textarea name="CST_68" style="width:100%;" class="er_fld_required"></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_signature" draggable="false" style="width: 50%;"> <i class="fa fa-pencil"></i><label class="er_fld_label required">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" class="er_fld_required"><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>
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