Forms for Adult Foster Care

Annual Licensing Visit Forms
Provider Forms
Resident Forms

AFC & CRS Home Safety Checklist (DHS-16-193581 9/21) (PDF)
AFC Foster Home In Use (71980-257 4/20) (Word) (PDF)
AFC Home Program Plan (71980-247 1/19) (Word) (PDF)
Evaluation of Agency by AFC Provider (71980-12a 11/10) (Word) (PDF)
Initial/Relicensing/Alternate Year Data Sheet (71980-234 12/16) (Word) (PDF)
License Applicant Privacy Rights (72000-2 7/17) (Word) (PDF)
Program Abuse Prevention Plan - Landscape view (DHS-16-180922 2015)(Word) (PDF)

Additional Forms for Relicensing Visits:

Certificate of Compliance - Workers' Compensation (PDF)
Family Systems Licensing Application - AFC (DHS-16-180907 5/17) (PDF)

FAQs

What are the initial licensing requirements for family adult foster care?

Applicants must live in Washington County.
Applicants must be at least 18 years of age.
All household members age 13 years and older must pass a criminal and social service background study. Applicants must pay for all studies. Each study costs $20. Fingerprints and photos are also required for each study at a cost of $9.10.
Applicants must complete all application materials including the names of three references (non-related).
Applicants must have a fire marshal inspection of the home at a cost of $50. The home must meet all applicable fire and building codes. Your licensor will arrange the inspection as a part of the licensing process.
Applicants must complete orientation training before taking a client in placement.
Applicants must complete vulnerable adult training.
Bedrooms in the home must meet size requirements.
Applicants and household members must cooperate with home study interviews.

How do I start the licensing process for family adult foster care?

All applicants must attend the Informational meeting. Times and dates are listed on the Community Services - Adult Foster Care Licensing section of the county website. Applicant materials are distributed at this meeting. No applicants will be accepted unless the person has attended this meeting. Applicants should complete the application and mail back to the county. Once the county receives the application, a licensing worker will be assigned and will contact you with further information. You must live in Washington County at the time you apply for licensing.

Do I have to live in a house to become licensed for family adult foster care?

Applicants can live in single- or multi-family dwellings. They can own or rent. If they rent, the owner must sign a consent form before the fire inspection can be completed. All homes must pass the fire inspection and meet all building codes. The home must be clean and in good order.

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Forms for Adult Foster Care

Additional Forms for Relicensing Visits:

These forms can be used as an index to the file:

These forms can be used as an index to the file:

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