ICW Home Study Reference Questionnaire

Name of Applicant(Required)
Name of Reference(Required)
4. If you needed someone to care for your child, either short or long-term, would you feel comfortable using the applicant(s)?(Required)
9. Do you think a child placed with the applicant(s) would be welcomed and accepted by their children, friends and relatives?(Required)
10. If a child is placed with the applicant(s) they will be given extensive, confidential information about the child’s background and birth family history. Do you think the applicant(s) will be able to keep this information confidential?(Required)

11. Most children placed in out of home care have been abused or neglected and often have behavior problems and/or special needs.

Often the most challenging times come after a child has been in the home for a while and the “newness” is over.Do you think these applicant(s) would remain committed to a child who is exhibiting difficult behaviors over aperiod of time?(Required)

12. Have you ever known the applicant(s) to experience problems (now or in the past) with any of the following:(Required)
13. Would you recommend the applicant(s) as a placement for children?(Required)
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