Iowa KidsNet

Thank you for your interest in foster care and adoption!

The following information is necessary in order to begin your journey. All information that you submit to Iowa KidsNet is completely confidential. If you decide to pursue a foster care license and/or adoption approval, we are required to submit your home study to the Iowa Department of Human Services and they are the only other workers who may access your information.

Please make sure everything you type in below is accurate and completed to the best of your ability. If you have difficulty completing this form, feel free to contact us at 1-800-243-0756.

The term "applicant" refers to the persons who will sign the applications for foster care and/or adoption. Applicants must be citizens of the United States, residents of Iowa, and age 21 or older. If there is only one applicant, do not complete any information under Applicant 2.

Fields marked with * are required

Applicant 1:

*Last Name
*First Name
Date of Birth	(mm/dd/yyyy)
Social Security Number
Cell Phone:
Day Phone:
*E-mail Address:
Occupation:

Applicant 2:

Last Name
First Name
Date of Birth	(mm/dd/yyyy)
Social Security Number
Cell Phone:
Day Phone:
E-mail Address:
Occupation:

Address:

Street/PO Box:
City:
State:
Zip:
County:
Home Phone:
What is your school district?
What elementary school do children in your area go to?

What best describes the race/ethnicity of the applicant/s?

What is the relationship status of the applicant/s?

Are the applicant/s legal residents of this country?

*How many adults (age 18 years or older) live in your home?

(This includes Applicant 1 and 2 and other adults who live with you all the time or only some of the time. It also includes college students who may come back holidays or the summer.)

*How many children live in your home?

(This includes children under the age of 18 years who live with you all of the time or only some of the time))

How many are 14 years or older?

If any of the adults (including applicants) or children age 14 and older resided in another state during the past 5 years, please list all states other than Iowa:

How are you interested in helping Iowa's children?

What generated your interest in foster care or adoption?

What is your interest level?

*Are you expecting any major life changes in the next several months (i.e. pregnancy, private adoption, marriage, divorce, separation, extended vacation, relocation, home renovation, etc.)?

*The process to become a foster and/or adoptive family can take up to 6 months or more. The training you are required to take is 3 hours per week (usually in the evenings) for 10 consecutive weeks. Will a commitment to training be a problem for you and/or a significant other/spouse?

*Foster care maintenance payments only cover a portion of the cost needed to provide foster care to one of Iowa's children. Will you be able to handle the financial responsibilities of fostering a child?

How did you learn about Iowa KidsNet?

If you talked with an Iowa KidsNet staff, please choose the staff:

If you were referred by DHS, please choose the worker who referred you:

Please enter the code you see below:

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