Host Home application

Open your home. Change a life.

A source-backed local draft for prospective Host Home providers.

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First name *Last name *Email address *Phone number *Street address *City *County *ZIP code *How many adults live in the home? *How many children live in the home? *Number of bedrooms *Bedrooms available for individuals *Do you own or rent your home? *Home type *Is the available bedroom on an accessible level? *Are there pets in the home? If yes, list type and number.List each household member’s name, relationship to you, and age.Describe the home and neighborhood, transportation, services, and activities.Have you supported people with intellectual or developmental disabilities? *Describe your caregiving, healthcare, behavioral-support, teaching, or community-service experience.Why do you want to become a Host Home Provider? *

Communication skillsAmerican Sign Language (ASL)Spoken EnglishVisual communicationCommunication devicesOther

When could you begin the approval process? *Willing to complete training, background checks, home study, inspections, and ongoing documentation? *

Reference 1Full name *Relationship *Phone *Email

Reference 2Full name *Relationship *Phone *Email

I certify the information is true and complete and understand approval requires screening, training, a home study, and other agency or DBHDD requirements.Electronic signature (full legal name) *Date *

Protected records stay protected. Public submissions are routed through Forever Care's approved workflow. Website access does not replace Microsoft 365 or SharePoint role-based permissions.