About Pulaski County CASA

"*" indicates required fields

1Basic Information

2I’m interested in…

Name*

First Last

Phone*

Email*

OK to text?*

Yes

By selecting Yes, you agree to receive periodic communications from Every Child Arkansas via SMS Text messages. You may opt out or unsubscribe at any time.

I am interested in

TYPE*

Fostering – I am ready to start the foster certification process

Fostering – I am just exploring and want to learn more about foster parenting

Volunteering – I would love to help children and families impacted by foster care

Adoption – Primarily needed for sibling sets and teens. There is not a current need for adoptive families for infants in the state

Zip Code*

At this time you may*

Continue to pre-application

Wait for communication from our team

Consent to Contact*

By submitting, you consent to us using your information to contact you.

Personal Info

Date of Birth*

MM slash DD slash YYYY

Address*

Street Address

City (AR)*

City*

State*

School District*

What School District are you in?

Gender*

Do you think of yourself as:*

Straight or heterosexual

Lesbian or gay

Bisexual

Queer or pansexual and/or questioning

Something else

Are you a US citizen or permanent resident?*

Yes

Do you have a reliable source of transportation?*

Yes

Are you currently receiving government assistance such as SNAP, TEA, or TANF?*

Yes

Are you part of a faith community/church?*

Yes

Name of Faith Community*

Which of the following languages do you feel comfortable communicating in with a child?*

English

Spanish

Other

Other Language

Race + Ethnicity*

Native American

Asian

Black

Latino

Pacific Islander

White

Prefer Not to Answer

Other

Other Race + Ethnicity*

Relationships

Relationship Status*

Other relationship status*

Partner information

Partners's Name*

First Last

Partner's Date of Birth*

MM slash DD slash YYYY

Partner's Gender*

Partner's Race + Ethnicity*

Native American

Asian

Black

Latino

Pacific Islander

White

Prefer Not to Answer

Other

Other (Partner's Race + Ethnicity)*

Household

Adults in household*

Children in household*

How many bedrooms do you have in your home?*

Fostering

How many children are you open to fostering at one time?*

What age range of child/ren are you open to fostering? (check all that apply):*

Birth – 23 months

2-5 years

6-8 years

9-10 years

11-12 years

13-14 years

15-17 years

I am open to fostering a child with ______. (check all that apply):*

Any

Developmental delays

Learning disabilities

Visual impairment

Emotional disabilities

Medical condition

Behavioral disorders

HIV/Aids

Intellectual disabilities

Hearing impairments

Physical disabilities

None of the above

Are you inquiring about a specific child that you know?*

Yes

If yes, whom?*

How did you hear about Every Child Arkansas? (check all that apply):*

Brochure

Church

Display/Info Booth

Event

Foster Parent

Friend or Colleague

Newspaper

Poster

Radio

Website

Relative

The Call

Adoption.com

Connected Foster Care

Restore Hope

Arkansas Baptist Children’s Home

Project Zero

Facebook

Foster Love

Together We Foster

Instagram

Yard Sign

Other (Please Specify)

If other, please specify*

Optional

Why do you want to foster?

Help us understand what brought you to the point of becoming a foster parent

Consent to Contact*

By submitting, you consent to us using your information to contact you.

About you

"*" indicates required fields

1Basic Information

2I'm interested in...

Name*

First Last

Phone*

Email*

OK to text?*

Yes

By selecting Yes, you agree to receive periodic communications from Every Child Arkansas via SMS Text messages. You may opt out or unsubscribe at any time.

I am interested in

TYPE*

Fostering - I am ready to start the foster certification process

Fostering - I am just exploring and want to learn more about foster parenting

Volunteering - I would love to help children and families impacted by foster care

Adoption - Primarily needed for sibling sets and teens. There is not a current need for adoptive families for infants in the state

Zip Code*

At this time you may*

Continue to pre-application

Wait for communication from our team

Consent to Contact*

By submitting, you consent to us using your information to contact you.

Personal Info

Date of Birth*

MM slash DD slash YYYY

Address*

Street Address

City (AR)*

City*

State*

School District*

What School District are you in?

Gender*

Do you think of yourself as:*

Straight or heterosexual

Lesbian or gay

Bisexual

Queer or pansexual and/or questioning

Something else

Are you a US citizen or permanent resident?*

Yes

Do you have a reliable source of transportation?*

Yes

Are you currently receiving government assistance such as SNAP, TEA, or TANF?*

Yes

Are you part of a faith community/church?*

Yes

Name of Faith Community*

Which of the following languages do you feel comfortable communicating in with a child?*

English

Spanish

Other

Other Language

Race + Ethnicity*

Native American

Asian

Black

Latino

Pacific Islander

White

Prefer Not to Answer

Other

Other Race + Ethnicity*

Relationships

Relationship Status*

Other relationship status*

Partner information

Partners's Name*

First Last

Partner's Date of Birth*

MM slash DD slash YYYY

Partner's Gender*

Partner's Race + Ethnicity*

Native American

Asian

Black

Latino

Pacific Islander

White

Prefer Not to Answer

Other

Other (Partner's Race + Ethnicity)*

Household

Adults in household*

Children in household*

How many bedrooms do you have in your home?*

Fostering

How many children are you open to fostering at one time?*

What age range of child/ren are you open to fostering? (check all that apply):*

Birth - 23 months

2-5 years

6-8 years

9-10 years

11-12 years

13-14 years

15-17 years

I am open to fostering a child with ______. (check all that apply):*

Any

Developmental delays

Learning disabilities

Visual impairment

Emotional disabilities

Medical condition

Behavioral disorders

HIV/Aids

Intellectual disabilities

Hearing impairments

Physical disabilities

None of the above

Are you inquiring about a specific child that you know?*

Yes

If yes, whom?*

How did you hear about Every Child Arkansas? (check all that apply):*

Brochure

Church

Display/Info Booth

Event

Foster Parent

Friend or Colleague

Newspaper

Poster

Radio

Website

Relative

The Call

Adoption.com

Connected Foster Care

Restore Hope

Arkansas Baptist Children's Home

Project Zero

Facebook

Foster Love

Together We Foster

Instagram

Yard Sign

Other (Please Specify)

If other, please specify*

Optional

Why do you want to foster?

Help us understand what brought you to the point of becoming a foster parent

Consent to Contact*

By submitting, you consent to us using your information to contact you.