Online Inquiry
Please attach a hard copy of this form below, or reenable the web form.
<ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Applicant Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_First_A"><i class="fa fa-font"></i><label class="er_fld_label required">First Name</label><input name="CST_1" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_Last_A"><i class="fa fa-font"></i><label class="er_fld_label required">Last Name</label><input name="CST_2" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address </label><input name="CST_3" type="text" class="er_fld_required"></li><li class="er_fld_type_number" draggable="false" style="width: 33.3333%;" map_to="FH_Phone_Home"><i class="fa fa-hashtag"></i><label class="er_fld_label required">Phone Number</label><input name="CST_4" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_First_B"><i class="fa fa-font"></i><label class="er_fld_label">Partner/Spouse First Name</label><input name="CST_5" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_Last_B"><i class="fa fa-font"></i><label class="er_fld_label">Partner/Spouse Last Name </label><input name="CST_6" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_MaritalStatus"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Relationship Status</label><select name="CST_7" class="er_fld_required"><option value="Single " selected="">Single </option><option value="Dating/Engaged">Dating/Engaged</option><option value="Married">Married</option><option value=""></option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_Years_Married"><i class="fa fa-caret-down"></i><label class="er_fld_label">If married, for how long? </label><select name="CST_8"><option value="N/A" selected="">N/A</option><option value="Less than 1 year">Less than 1 year</option><option value="Between 1 and 2 years ">Between 1 and 2 years </option><option value="2 years or more ">2 years or more </option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Home Address </label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Address_Street_1"><i class="fa fa-font"></i><label class="er_fld_label required">Street Address</label><input name="CST_9" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Address_Street_2"> <i class="fa fa-font"></i><label class="er_fld_label">Apartment # (if applicable) </label><input name="CST_10" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_City"><i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_11" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_State"><i class="fa fa-font"></i><label class="er_fld_label required">State</label><input name="CST_12" type="text" class="er_fld_required" value=""></li><li class="er_fld_type_number" draggable="false" style="width: 20%;" map_to="FH_Address_Zip"><i class="fa fa-hashtag"></i><label class="er_fld_label required">Zip Code </label><input name="CST_13" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_County"> <i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_14" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 100%;" map_to="FH_NumBedrooms"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How many bedrooms are in your home? </label><select name="CST_15" class="er_fld_required"><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5+">5+</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="Location"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Which TBHC Office are you closest to? </label><select name="CST_16" class="er_fld_required"><option value=""></option><option value="Bedford">Bedford</option><option value="Richardson">Richardson</option><option value="Waxahachie">Waxahachie</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false" map_to="none"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Do you attend a church in your area? </label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_17" value="No">No</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_17" value="No, but I'm interested in finding a church">No, but I'm interested in finding a church</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_17" value="Yes, and they have a foster care & adoption ministry">Yes, and they have a foster care & adoption ministry</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_17" value="Yes, but they don't have a foster care & adoption ministry">Yes, but they don't have a foster care & adoption ministry</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_17" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_17_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Church"> <i class="fa fa-font"></i><label class="er_fld_label">What is the name of your Church? (if applicable)</label><input name="CST_18" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>TBHC Connection </label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_ReferralSource"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">How did you find out about TBHC? </label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Google (TBHC Website)">Google (TBHC Website)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Facebook">Facebook</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Instagram">Instagram</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I went to a Foster Care & Adoption Event ">I went to a Foster Care & Adoption Event </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I'm connected with a TBHC Foster/Adopt family ">I'm connected with a TBHC Foster/Adopt family </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Family Member or Friend ">Family Member or Friend </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="My Church">My Church</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I've attended a General Information Meeting (GIM)">I've attended a General Information Meeting (GIM)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="CPS/DFPS ">CPS/DFPS </label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_19" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_19_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">Please answer any of the following 3 questions only if applicable:</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Inquiry_How_Referred"> <i class="fa fa-font"></i><label class="er_fld_label">What Foster Care & Adoption Event did you attend?</label><input name="CST_20" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_ReferredByName"> <i class="fa fa-font"></i><label class="er_fld_label">Who is the TBHC family you know? </label><input name="CST_21" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="none"> <i class="fa fa-font"></i><label class="er_fld_label">When did you attend a General Information Meeting? (MM/DD/YY)</label><input name="CST_22" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Foster/Adopt Interest</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Interested In:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Fostering ">Fostering </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Fostering (with ability to Adopt)">Fostering (with ability to Adopt)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Adopting ">Adopting </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Kinship ">Kinship </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="TBHC Private Infant Adoption program">TBHC Private Infant Adoption program</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Donating/Volunteering with TBHC">Donating/Volunteering with TBHC</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_23" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_23_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Why_Parents"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Why do you desire to foster and/or adopt? </label><textarea name="CST_24" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small er_fld_selected" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Comments"> <i class="fa fa-paragraph"></i><label class="er_fld_label required">Do you have any concerns that TBHC should be made aware of prior to starting the licensing process with you? </label><textarea name="CST_25" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Questions? </label><textarea name="CST_26" style="width:100%;" class="er_fld_required"></textarea></li></ul>
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