Foster Application * indicates required fields    *Applicant Full Name::   *Spouse Full Name::   *Are You Over 18 ?: Yes No   *Type Of Application ?:  New Application  Modification  Location Change   *Total Capacity Requested::   Please Select All That Applies::  None  Previously Licensed  Certified  Approved   Please Select One:: None Previous Denial Exclusion Revocation Administrative Action Decertification   Dates Of Boxes Checked Above::   Type Of License::   Address Of Previous License::   License Number:   *Residence Address:   *Please Select:  Own  Rent  Lease   Major Cross Streets:   *Days & Hours You Can Be Reached:   *Home Phone:   *Number Of Children In Your Home:   *Relationship To You:   *Adults In The Home: Yes No   *Relationship To You:   *Foster Child Preferred Age:  Any  0-2 Years  2-9 Years  10-17 Years   *Foster Child Preferred Sex: Any Female Male   *Type:  Non-Ambulatory  Ambulatory  Special HealthNeeds