Beacon Home Application

Thank you for your interest in becoming a Beacon Home! This application is for all volunteers interested in opening their home and giving their family to a child in need of a safe place to stay while you, other volunteers, and our staff work with their parents to develop a sustainable home and family life.  Please have your spouse (co-applicant) with you to fill this form out before you begin.  It will take you approx. 45 minutes to complete.

All Family Beacon volunteers must complete this application. Please identify the appropriate role(s) for which you are applying.

Personal Background

Applicant 1:




Gender








Applicant 2:




Gender








Your Home

Home Address



Home Information: Is there any type of business operated from the residence?


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Home Description (check all that apply):

Construction:

Indoor Space:


Outside Space:

Arrangement:

Description of Home (for Beacon Homes only):

Sleeping Arrangements (include estimated square footage of each room and the floor or level the room is located on. If the room is occupied, please provide the occupants. Indicate where a child or children are available to sleep. Indicate the type of bed they will be able to use (ex. crib, twin, full, queen, bunk. If a bunk is available, indicate if it is upper or lower bed.)































Family Composition (for Beacon Homes only):

List of all people living in the home not including the applicant(s).


Gender





Gender





Gender





Gender





Gender





Gender




Transportation

Will your vehicle(s) be used to transport children?

Does the applicant(s) have proof of insurance?

Please provide copy of applicant(s) drivers' license with application.

List of all household members (and others if applicable) who you want approved to transport minors in your care including applicant(s):



Applicant 1:


Applicant 2:


Financial Information:

Income:


Support Network (for Beacon Homes only):

From your church, who would you recommend to be your Home Coach? (They will receive training and conduct weekly home visits to provide ongoing support to you during the placement.)




From your personal support network, who could help with childcare? (List as many as 4 people and their email.)








If you had a crisis, who would you call? (List as many as 2 people and their email.)



Employment History:

Applicant 1:














Have you ever been terminated or asked to resign?

Applicant 2:














Have you ever been terminated or asked to resign?

Educational History:

Please list the high school and college (if applicable) you attended and answer the following.

Applicant 1:

What is the highest level of education completed?









Applicant 2:

What is the highest level of education completed?









Beacon Home Hosting Information (for Beacon Homes only)



What gender(s) are you interested in hosting in your home?



Support of Client Family (Biological Family): Are you interested in developing a relationship with the biological family of the child in your care?

References:

Please provide the contact information and relationship type for three references. Include one pastoral reference and two others who can provide moral, prayer, and material support during your hosting.













Terms of Acceptance and Signature

Applicant 1


Electronic Signature: *


Applicant 2


Electronic Signature: *