Family Home Provider Interest Assessment
Thank you for your interest in Community Options Integrated Services, Inc. (COIS). Before moving forward, we want to be sure you understand the responsibilities of the Family Home Provider/Adult Foster Care position.

We are looking to meet individuals and families who are interested in opening their private home/residence to support a person with a developmental/intellectual disability.

Your completion of this form will help us identify your understanding and readiness to become a certified adult foster provider with Community Options Integrated Services, Inc. Please answer all questions honestly and to the best of your ability.

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Email *
Through COIS, opening your home to an individual with a developmental/intellectual disability means providing day to day nurturing care and support in the following areas:  activities of daily living, community integration/inclusion, and promoting/monitoring health and wellbeing.                                                                              With the right match in mind and agency support from COIS, are you willing and able to provide this type of support and care? *
How did you hear about becoming a Family Home Provider with COIS? *
Are you interested in opening your own private home and your heart to mentor and care for an adult with a intellectual/developemental disabilitiy?  (This is an independent contractor/foster care position) *
Are you one of the major heads of households of a home (rented/leased/owned) with a private bedroom available to support an individual with an intellectual/developmental disability?                                         *
Would you be open to providing support to more than one individual with an intellectual/developmental disability? (No more than 2 clients and each must have their own private bedroom.) *
How soon are you looking to join COIS as an independent contractor/foster care family home provider? *
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