Arizona Administrative Code › Title 21 - CHILD SAFETY › Chapter 6 - DEPARTMENT OF CHILD SAFETY - FOSTER HOME LICENSING › Article 4 - THE LICENSING PROCESS FOR FOSTER PARENTS › Section R21-6-403 - Application for an Initial License

Current through Register Vol. 30, No. 28, July 12, 2024
A. An individual or married couple shall
				complete the application for an initial license accurately and in full via the
				Department's electronic database. The applicant may direct the licensing agency
				to enter the application.
B. The
				application for an initial license shall include:
1. The full legal name of each household
				member;
2. All other names and
				aliases, including birth names and names used in previous marriages, of each
				household member;
3. The current
				marital status of the applicant;
4.
				The date of birth of each household member, except other foster children,
				including evidence that the applicant is at least 21 years of age;
5. The Social Security Number of each adult
				household member, for the purpose of conducting a background check;
6. The relationship between the applicant and
				all other household members, including a parent, sibling, housemate, or
				tenant;
7. The telephone number and
				e-mail address of the applicant;
8.
				The mailing address of the applicant and the physical address of the
				applicant's home;
9. A statement
				that the applicant resides in Arizona;
10. The document specified under A.R.S.
				§
										41-1080(A)
				 and, as applicable (E), to demonstrate that
				the applicant is lawfully present in the United States;
11. The name of the school district in which
				the applicant's home is located;
12. Each address held by each adult household
				member during the previous 10 years;
13. The name, date of birth, current address,
				and telephone number of each child of the applicant who lives outside the
				applicant's home, if known, and a statement as to whether the child is
				reasonably expected to have contact with a child in foster placement;
14. The applicant's employment history,
				including the names of employers, dates of employment, and positions held
				during the previous 10 years;
15. A
				summary of the applicant's education;
16. A description of the applicant's
				experience in caring for children or adults;
17. The applicant's household budget, showing
				income, resources, assets, debts, and obligations;
18. Plans for the sleeping arrangements for
				each household member and for each potential foster child;
19. Plans for transportation of each
				potential foster child including:
a. Evidence
				of a valid driver license for each household member who will provide
				transportation;
b. Evidence that
				each vehicle to be used for transportation is registered and insured to operate
				in Arizona; and
c. Evidence that
				the applicant has or shall obtain prior to placement, the correct number and
				type of child car seats for the conditions of the license.
20. A description of any pool on the foster
				home premises;
21. A description of
				the applicant's prior efforts to be certified or licensed for adoption, foster
				care, assisted living, child-care, and any other service for children or
				vulnerable adults, including:
a. Applications
				that were withdrawn or denied; and
b. Applications that resulted in a license or
				certification that was suspended or revoked.
22. A list of the names, mailing and e-mail
				addresses, and telephone numbers of five references, to attest that the
				applicant is of good character and has the qualifications to care for a foster
				child:
a. At least one of the references, but
				not more than two, shall be related to the applicant;
b. At least three of the references shall be
				unrelated to the applicant;
c. If
				the applicant is married, then at least two of the references shall be familiar
				with the applicant as a couple; and
d. If another adult household member is
				applying for a license or is currently licensed, then at least two of the
				references shall be familiar with both the applicant or foster parent and other
				household member.
23. A
				disclosure of civil and court proceedings in which the applicant has been a
				party, including:
a. Criminal
				proceedings;
b. Lawsuits;
c. Dependency actions, including:
i. Removal of a dependent,
ii. Voluntary relinquishment,
iii. Suspension of custody, or
iv. Termination of parental rights;
d. Charges of child abuse or
				neglect;
e. Child support
				enforcement proceedings within the last five years;
f. Bankruptcy within the last five
				years;
g. Divorce, separation, or
				any other civil proceedings; and
h.
				Adoption;
24. A criminal
				record self-disclosure completed by each adult household member;
25. Evidence that each adult household
				member, has obtained a Level One fingerprint clearance card;
26. A disclosure by the applicant of any
				allegation against the applicant of abuse or neglect of any child or vulnerable
				adult;
27. Any history of abuse or
				neglect involving the applicant;
28. Authorization for a Central Registry
				record check:
a. For each adult household
				member, and
b. With each state in
				which any adult household member resided in during the previous five
				years.
29. A health
				self-disclosure completed by each adult household member;
30. A physician's statement as defined in
				R21-6-101(54), related to the physical and behavioral health completed for the
				applicant and for each adult household member who will be providing care and
				supervision;
31. An up-to-date
				immunization record, if available, for each child household member. The lack of
				available immunization records shall not prohibit licensure, but may be grounds
				for restricting the license to prevent the placement of infants, young
				children, and medically complex individuals; and
32. A Statement of Understanding signed by
				the applicant and attesting to the truth of the information provided during the
				application process.