| Date |
|
| Parent’s Name(s) |
|
| Address |
|
| Phone Number(s) |
|
| Purpose of Home Study |
|
| Composition of Family |
|
| Desired characteristics of child |
|
Families strengths and attributes |
|
| Have you ever had a Home Study? |
|
| If so, what were the results? |
|
| Are your circumstances different today? |
|
| Does anyone in your home have a criminal history? |
|
If so, please explain |
|
| Has anyone in your home been investigated by Child Protective Services? |
|
If so, what was the outcome? |
|
| When is the best time for you to talk on the phone? |
|
| When is the best time for you to meet? |
|