Better, Brighter Futures for Kids

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Adoption & Intensive Foster Care MAPP Pre-Screening

THE HOME FOR LITTLE WANDERERS

Inquirer 1

Inquirer 2

Age range Select all that apply

Please answer the following questions. Your answers will be used to determine areas for further discussion

Additional Household Members

Household Information

Do you have other household members?
Children?
Dogs?
Do you?
Number of Bedrooms

Child Interest Characteristics

Age range Select all that apply
Race/Ethnicity (Select all that apply)
Siblings
Legal Risk
Physical Challenges
Behavioral Issues
Cognitive Limitations
Mental Health History (child or family)

Personal Information (please respond for either inquirer as applicable)

Have you ever been legally involved, detained, charged and/or arrested by the police?
Have you ever had a negative home study?
Have you ever been involved with DCF as an adult/child/reporter?
Have you struggled with infertility?
Do you currently have any serious medical conditions?
Have you had serious medical conditions in the past?
Does anyone in your household smoke/vape?
Are you prescribed any medications?
Does anyone in your household have a history of substance abuse?
Does anyone in your household have a history of domestic violence?
Has anyone in your household ever received mental health services?
Are you currently working with an agency?
Have you ever worked with a foster care agency in the past?

Adoption/IFC Information

Where are you in this process?
I/we understand the process of adopting from foster care
I/we understand the home study process
I/we understand the needs of the children in care
I/we understand the typical age of children
I/we understand the concept of “legal risk” in adoption
Do you know others who have adopted or fostered?
Do you know others who have adopted from foster care?
Do you know others who have been adopted or fostered?
Do you know the difference between IFC and DCF foster care?
Which program are you interested in? (Select all that apply)
Or print and mail back this
questionnaire to our Foster Care & Adoption Team.

The Home for Little Wanderers
Attn: Foster Care & Adoption Team
10 Guest Street
Brighton, MA 02135

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