CP&P Form 14-158
(rev. 3/2009)
State of New Jersey
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Child Protection and Permanency
INQUIRY FORM
Completed by:
Inquiry Date:
Office:
Telephone Number Utilized:
1-877-NJ-FOSTER
1-800-222-0047
1-800-99-ADOPT
1-609-520-1500
Resource Family Support Unit
How did you hear about the need for foster/adoptive parents?
Newspaper – specify name:
Mass Media TV _________
radio _____
Recruitment material – specify:
Transit – specify:
Faith-based activity – specify:
Personal contact – specify:
Telephone Book/Yellow Pages
Resource Family: (specify name for Honorarium):
Recruitment event – specify:
CP&P Staff – name:
Other – specify:
Area(s) of Interest:
Internet – specify:
Foster Care
Adoption
Foster Care with Interest in Adoption
Heart Gallery (name of child):
Primary Inquirer:
First Name:
Secondary Inquirer: First Name:
Last Name:
Last Name:
Address: Street:
State:
County:
Mailing Address (if different than above)
City:
Zip:
City:
Zip:
E-Mail Address:
Street/P.O. Box:
State:
County:
Telephone Numbers - Primary Inquirer:
Home:
Work:
Would you be willing to consider a sibling group?
Comments:
Yes
Undecided
MI:
MI:
Cell:
No
Undecided