ACS - Child Welfare - Prospective Parent Recruitment Form

Administration for Children's Services

Keeping Children Safe & Supporting Families


Become a Foster or Adoptive Parent

Become a Foster or Adoptive Parent
Foster/Adopt Frequently Asked Questions
Family Stories
Foster Parent’s Guide To Education

Become a Foster or Adoptive Parent

Foster/Adopt Frequently Asked Questions

Family Stories

Foster Parent’s Guide To Education


Prospective Foster and/or Adoptive Parent Recruitment Form

Thank you for your interest in becoming a foster parent to children and youth with New York City Administration for Children’s Services (ACS).

Although, the number of child/youth has reduced each year due to ACS’ focus on strengthening our preventive services and prioritizing kinship care (placement with families), we continue to need safe, loving homes for children/youth who require an out of home placement (foster care placement). In particular, New York City’s foster care continuum is seeking foster parents willing and able to provide a stable and loving home to the following:

Children and youth with complex behavioral health, developmental and medical needs

Adolescent youth ages 14-17

Children who are part of sibling groups of 3 or more

We look forward to matching you with one of our foster care agencies located within the five boroughs who will provide you with critical information, guidance and support throughout the process. In order to match you with an agency, we have a couple of questions. We encourage all interested applicants to complete the Foster or Adoptive Parent Recruitment Form. Please be advised that answering, “no” to any of the below questions is not an automatic disqualifier.

Please select your community district:

Select a Borough: *

--Select--

Bronx

Brooklyn

Manhattan

Queens

Staten Island

Outside NYC

Select a Community: *

--Select--

Please let us know your willingness and/or interest in providing a loving, safe home for child/youth with (Please check all that apply):*
Behavioral needs
Developmental needs
Medical needs
Adolescent/teenagers
Sibling group
Not interested at this time

Do you have any experience in providing supports and/or working on behalf of children/youth with (Please check all that apply):*
Behavioral needs
Developmental needs
Medical needs
Adolescent/teenagers
Sibling group
No experience at this time

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Prospective Parent Information

Information collected will be used for internal data purposes only!

First Name *

Middle Initial

Last Name *

Suffix

What is your current occupation?*

-Select-

Childcare provider/Babysitter

School Personnel/Teacher/Teacher Aide/Counselor etc.

Medical Field/Doctor/Nurse/Nurse Aide/Technician etc.

Mental Health Provider

Self-Employed

Retired, please specify in the text box below

Unemployed, please specify in the text box below

Other, please specify in the text box below

N/A, Explain in the text box below

You may specify/explain your occupation here:

Primary Contact Type *

-Select-

Home

Cell

Work

Primary Number (e.g., 212-555-1234) *

Alternate Contact Type #2

-Select-

Home

Cell

Work

Alternate Contact Number (e.g., 212-555-1234)

Best Time to Be Reached *

-Select-

9AM to 12PM

12PM to 5PM

5PM to 7PM

E-mail Address *

If you do not have an e-mail address, please contact the WISH Line at 877-676-WISH (9474).

How did you hear about the foster/adoptive program?*

-Select-

Word of Mouth

Internet (Please identify website below)

ACS Website

311

Heart Gallery

Other (Please Specify Below)

Please Specify:

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Home Information

House Number *

Street Name *

Apt #

City *

State *
-Select-

Zip Code *

Area of Interest *

-Select-

Fostering

Adopting

Both

Community District *

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