Interest Form Step 1 of 5 20% Which Upbring office is closest to you?(Required)AmarilloAustinDallasEl PasoFort WorthHarlingenHoustonLaredoLubbockMcAllenSan AntonioTylerVictoriaHow did you hear about Upbring?(Required)BillboardBlogChurchDFPS Information MeetingFacebookFamily/FriendGoogleChatGPT / AI SearchInstagramNewspaper AdRadioRecruitment Event – OtherStaffTV CommercialWalk in/Drive ByWeb SearchWho can we thank? Caregiver 1Last Name(Required)First Name(Required)Middle NameMaiden Name (if applicable)Cell Phone Phone(Required)Work PhoneEmail(Required) Birth Date(Required) MM slash DD slash YYYY GenderFemaleMaleSecond Applicant Add a second applicant Caregiver 2Last Name(Required)First Name(Required)Middle NameMaiden Name (if applicable)Cell Phone Phone(Required)Work PhoneEmail(Required) Birth Date(Required) MM slash DD slash YYYY GenderFemaleMale Mailing AddressAddress(Required)Address Line 2City(Required)State(Required)TexasAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code(Required)County(Required)AndersonAndrewsAngelinaAransasArcherArmstrongAtascosaAustinBaileyBanderaBastropBaylorBeeBellBexarBlancoBordenBosqueBowieBrazoriaBrazosBrewsterBriscoeBrooksBrownBurlesonBurnetCaldwellCalhounCallahanCameronCampCarsonCassCastroChambersCherokeeChildressClayCochranCokeColemanCollinCollingsworthColoradoComalComancheConchoCookeCoryellCottleCraneCrockettCrosbyCulbersonDallamDallasDawsonDe WittDeaf SmithDeltaDentonDickensDimmitDonley DuvalEastlandEctorEdwardsEl PasoEllisErathFallsFanninFayetteFisherFloydFoardFort BendFranklinFreestoneFrioGainesGalvestonGarzaGillespieGlasscockGoliadGonzalesGrayGraysonGreggGrimesGuadalupeHaleHallHamiltonHansfordHardemanHardinHarrisHarrisonHartleyHaskellHaysHemphillHendersonHidalgoHillHockleyHoodHopkinsHoustonHowardHudspethHuntHutchinsonIrionJackJacksonJasperJeff DavisJeffersonJim HoggJim WellsJohnsonJonesKarnesKaufman KendallKenedyKentKerrKimbleKingKinneyKlebergKnoxLa SalleLamarLambLampasasLavacaLeeLeonLibertyLimestoneLipscombLive OakLlanoLovingLubbockLynnMadisonMarionMartinMasonMatagordaMaverickMcCullochMcLennanMcMullenMedinaMenardMidlandMilamMillsMitchellMontagueMontgomeryMooreMorrisMotleyNacogdochesNavarroNewtonNolanNuecesOchiltreeOldhamOrangePalo PintoPanolaParkerParmerPecosPolkPotterPresidioRainsRandallReaganRealRed RiverReevesRefugioRobertsRobertsonRockwallRunnelsRuskSabineSan AugustineSan JacintoSan PatricioSan SabaSchleicherScurryShackelfordShelbyShermanSmithSomervellStarrStephensSterlingStonewallSuttonSwisherTarrantTaylorTerrellTerryThrockmortonTitusTom GreenTravisTrinityTylerUpshurUptonUvaldeVal VerdeVan ZandtVictoriaWalkerWallerWardWashingtonWebbWhartonWheelerWichitaWilbargerWillacyWilliamsonWilsonWinklerWiseWoodYoakumYoungZapataZavalaPhysical Address My Physical Address is different from mailing address Physical AddressAddress(Required)Address Line 2City(Required)State(Required)TexasAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code(Required)County(Required)AndersonAndrewsAngelinaAransasArcherArmstrongAtascosaAustinBaileyBanderaBastropBaylorBeeBellBexarBlancoBordenBosqueBowieBrazoriaBrazosBrewsterBriscoeBrooksBrownBurlesonBurnetCaldwellCalhounCallahanCameronCampCarsonCassCastroChambersCherokeeChildressClayCochranCokeColemanCollinCollingsworthColoradoComalComancheConchoCookeCoryellCottleCraneCrockettCrosbyCulbersonDallamDallasDawsonDe WittDeaf SmithDeltaDentonDickensDimmitDonley DuvalEastlandEctorEdwardsEl PasoEllisErathFallsFanninFayetteFisherFloydFoardFort BendFranklinFreestoneFrioGainesGalvestonGarzaGillespieGlasscockGoliadGonzalesGrayGraysonGreggGrimesGuadalupeHaleHallHamiltonHansfordHardemanHardinHarrisHarrisonHartleyHaskellHaysHemphillHendersonHidalgoHillHockleyHoodHopkinsHoustonHowardHudspethHuntHutchinsonIrionJackJacksonJasperJeff DavisJeffersonJim HoggJim WellsJohnsonJonesKarnesKaufman KendallKenedyKentKerrKimbleKingKinneyKlebergKnoxLa SalleLamarLambLampasasLavacaLeeLeonLibertyLimestoneLipscombLive OakLlanoLovingLubbockLynnMadisonMarionMartinMasonMatagordaMaverickMcCullochMcLennanMcMullenMedinaMenardMidlandMilamMillsMitchellMontagueMontgomeryMooreMorrisMotleyNacogdochesNavarroNewtonNolanNuecesOchiltreeOldhamOrangePalo PintoPanolaParkerParmerPecosPolkPotterPresidioRainsRandallReaganRealRed RiverReevesRefugioRobertsRobertsonRockwallRunnelsRuskSabineSan AugustineSan JacintoSan PatricioSan SabaSchleicherScurryShackelfordShelbyShermanSmithSomervellStarrStephensSterlingStonewallSuttonSwisherTarrantTaylorTerrellTerryThrockmortonTitusTom GreenTravisTrinityTylerUpshurUptonUvaldeVal VerdeVan ZandtVictoriaWalkerWallerWardWashingtonWebbWhartonWheelerWichitaWilbargerWillacyWilliamsonWilsonWinklerWiseWoodYoakumYoungZapataZavala Criminal HistoryFailure to disclose Criminal History or History with CPS could result in denial of your application.Has either applicant or household member ever been arrested, convicted of, or received deferred adjudication for a crime other than a minor traffic ticket, to include crimes against the person, crimes against the family, and/or public indecency to a child?(Required) No Yes If Yes, which applicant and explain:(Required)Has either applicant or household member ever had a history with Child Protective Services, including but not limited to – a finding of Reason to Believe for any type of abuse or neglect of a child?(Required) No Yes If Yes, which applicant and explain:(Required) QuestionnaireThank you for your interest in becoming a foster care provider. The following questions are designed to help us understand your background and suitability for fostering. Please note that your responses will not disqualify your application. What services are you interested in?(Required) Foster Care Only Foster to Adopt Adoption Only Kinship Are you interested in any of the following?(Required) A child with special needs A child with behavioral needs A child with primary medical needs Are you currently a foster or kinship provider?(Required) Yes No What is your relationship status?(Required) Single Married Separated Divorced Total number of household membersChildren(Required)Adults(Required)Please enter a number greater than or equal to 1.Are applicants emotionally and physically healthy?(Required) Yes No Are you able to financially support your household prior to foster care reimbursement?(Required) Yes No Upbring – Foster in Texas maintains confidentiality of all information provided. At no times will your file be released to any other agency beyond our own without prior written permission within the limits of Texas law. This document will be reviewed by representatives of the Department of Family and Protective Services during scheduled program and contract reviews/audits.
