Intellectual & Developmental Disabilities Services Child Foster Home Provider Background Check
The information collected on this form is used to start the criminal history background check process with the Oregon Department of Human Services/Oregon Health Authority Background Check Unit for new and renewing I/DD Child Foster Home (CFH) providers (licensees, respite caregivers and occupants of the home who are not caregivers).

A valid email address is required for the background check application process. 

  • After this completed form is received, you will be sent an email from the ORCHARDS Background Check system for completing your background check application online. Please watch your spam/junk email folder for this email.

Sign in to Google to save your progress. Learn more
Email *
Name *
Enter your name EXACTLY as it appears on your ID (first name, middle name, last name)
Please list any previous alias' you have used. List First and Last Name *
Your Address *
Mailing Address
If different from your address above.
If you have lived outside of the State of Oregon for more than 60 days in the last 5 years, please list your address and the years you lived there. *
Date of Birth *
MM
/
DD
/
YYYY
Foster Family Name *
For respite caregivers and non-caregiving occupants, please provide the name of the Child Foster Family you provide respite for or live with.
Are you renewing your I/DD foster care background check or is this a new background check? *
Gender *
Phone Number *
By clicking 'Yes", you are electronically authorizing Seniors and People with Disabilities to conduct a record check through Children, Adults and Families (DHS/CW) for any child abuse/neglect records and foster home certification records regarding yourself. *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Multnomah County. Report Abuse
Google Forms