2. Washington County Department of Social Services

   
   

   383 Broadway, Fort Edward, NY 12828

   Telephone (518)-746-2300

   Fax (518) 746-2360

   Tammy L. DeLorme, Commissioner

3. 
7. Initial Inquiry Data Form: Foster Care Recruitment HOPE Unit
9. Form Completed Date
   Form Completed Date
11. First Name
12. Last Name
14. Address1
16. Address2
18. City
19. State
20. Zip
22. Phone Number
23. Cell Phone Number
25. Email Address
26. How would you prefer to be contacted?
    -- Select One --Home PhoneCell PhoneEmail
30. Additional Information
32. Name(s) of prospective foster parents and household composition: (please include dates of birth)
34. Inquiry Type:
36. Adoption/Foster Care or Both
    -- Select One --AdoptionFoster CareBoth
37. Child Age Range Preferred
38. Gender Preferred
    -- Select One --FemaleMaleNo Preference
40. How did you hear about Washington County's Foster Home Recruitment?
42. Have you been a foster parent prior?
    -- Select One --YesNo
43. What Agency?

45. Thank you for completing this inquiry form. Someone from the Washington County Foster Care Recruitment HOPE Unit will be in contact with you to talk about the program and your specific interest.

Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field