Applicant Information

Applicant Name: Address: Phone Number: Email: Date of Home Study:

Home Environment

Safe, clean, and hygienic living environment

Functioning smoke detectors on every floor

Fire extinguisher accessible and maintained

First aid kit available

Working heating and cooling systems

Safe, working utilities (water, electricity, gas)

Neat and uncluttered household

Adequate lighting throughout home

Enough bedrooms for all family members

Separate bed and storage for foster child

Window(s) in each bedroom

Safe and clean sleeping area

Clean and sanitary food preparation area

Safe and working appliances

Proper food storage

Toxins and cleaning products stored securely

Clean and sanitary

Working toilet, sink, and shower/bath

Privacy locks

Towels and toiletries available

Hazardous items locked away (medications, weapons)

No exposed wiring or hazards

Emergency numbers posted and accessible

Safe outdoor play area

Child gates or other safety devices, if needed

Health records of all family members

Proof of income/employment

Background checks completed

References received

Proof of homeowner's/renter's insurance

Copies of marriage/divorce certificates (if applicable)