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2. Foster or foster-to-adopt inquiry
   Thank you for your interest in becoming a foster or foster-to-adopt parent for Onslow County Department of Social Services. If you are not currently licensed as a foster parent and are interested in obtaining additional information about our foster or foster-to-adopt parent program, please complete this inquiry form. After completing the inquiry form, you will receive a phone call from our Licensing Supervisor within three business days. If you have any questions, you may also contact 910-219-1956 or email john_heinzman@onslowcountync.gov.
4. Please complete all the required fields below.
6. Last Name*
7. First Name*
9. Street Address*
10. Apartment or Suite
12. City*
13. State*
14. ZIP Code*
16. Phone number*
17. email address*
19. Gender*

    1. Male
    2. Female
    3. Nonbinary
20. Date of Birth*
21. Marital Status*

    1. Married
    2. Single
    3. Divorced

    1. Widowed
    2. Domestic Partner
    3. Other
25. Please provide information regarding any other family members residing in the home:
27. Name
28. Gender

    1. Male
    2. Female
    3. Nonbinary
29. Date of birth:
30. Relationship
    -- Select One --SpouseDomestic PartnerChildSiblingParentOther family member
32. Name
33. Gender

    1. Male
    2. Female
    3. Nonbinary
34. Date of birth:
35. Relationship
    -- Select One --SpouseDomestic PartnerChildSiblingParentOther family member
37. Name
38. Gender

    1. Male
    2. Female
    3. Nonbinary
39. Date of birth
40. Relationship
    -- Select One --SpouseDomestic PartnerChildSiblingParentOther family member
42. Name
43. Gender

    1. Male
    2. Female
    3. Nonbinary
44. Date of birth
45. Relationship
    -- Select One --SpouseDomestic PartnerChildSiblingParentOther family member
47. Name
48. Gender

    1. Male
    2. Female
    3. Nonbinary
49. Date of birth
50. Relationship
    -- Select One --SpouseDomestic PartnerChildSiblingParentOther family member
54. Interested in:

    1. Fostering

    1. Foster-to-adopt
55. Where/how did you hear about us?*
    -- Select One --Recruitment eventAdvertisementInternet searchWord-of-mouthOther
57. Gender preference of child(ren) to foster:

    1. Male
    2. Female
    3. Either/Both
58. Age(s) preferred:

    1. 0-3 years old
    2. 4-6 years old
    3. 7-9 years old
    4. 10-12 years old
    5. 13-15 years old
    6. 16-18 years old

    You can choose more than one age group.

60. Comments:
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field