Amendment status not verified — confirm the current text below against the official source.
Out of these the number of children who availed the services only during the day in the month: Signature In charge of the Open Shelter Home ¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 299 FORM 30 [Rule 23(9)] HOME STUDY REPORT FOR PROSPECTIVE FOSTER PARENTS DATE OF REGISTRATION - AADHAR CARD NO of PFP : - NAME OF THE SOCIAL WORKER - DATE OF HOME VISIT - Part-I of the format shall be filled up by the prospective Foster parents and Part-II of the template shall be filled up by the Social Worker to submit an assessment report along with his/her observation about suitability of the prospective adoptive/ foster parents. PART-I : SELF ASSESSMENT A. Information about the prospective foster parents and their family background Particulars of the foster parents Full Name Date of birth & age Place of birth Complete Address with e-mail ID (Present & Permanent Address) Identity Proof Religion Language(s) Date of Marriage Present Educational Qualification Employment/occupation Name & Address of the present Employer/Business concern Annual Income Health Status 300 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] B. Family background information: (1) Give a short description of social status and background of the prospective foster parents along with the following information. Details about Parents of the Applicants Father Mother Name in full Age Nationality/Citizenship Occupation Previous occupation Presently residing with (2) Please complete the following table with the names of each of your respective children (adopted and biological), their sex, educational status (kindergarten, elementary, etc.) and dates of birth. Name of the Child Sex Date of Birth Educational Status (3) If there are other members residing, please furnish the following information in respect of them. Name Nature of Relationship Age Gender Occupation (4) Please describe how you believe the foster care would affect the family members (grand parents, children, relatives and others). ¹Hkkx IIµ[k.M 3(i)º Hkkjr dk jkti=k % vlk/kj.k 301 C. Professional/Employment Details (Professional career details for last 5 years): Foster Father Organisation Employer Details (Name & Address) Job Title From To Foster Mother Organisation Employer Details (Name & Address) Job Title From To D Financial Position: (Give a short description of your income from all sources such as savings, investments, expenditures and liabilities and debts along with supporting documents)………………………………………………………………. E Description of Home and Neighbourhood: (Describe the accommodation details and neighbourhood relationship) (1) How many rooms do you have in your home and describe the play area available for the child................................. (2) Please describe the neighbourhood in which you reside, including any aspect that you believe makes it child-friendly…………………… F. Attitude and Motivation for foster care: (1) Please circle the term which best describes the reason why you wish to take a child in foster care, you may circle more than one option, if applicable: a) Provide a companion to your other children; b) Provide a child with a happy home; c) Other, please specify ………………………………. (2) Please circle the statement which describes how you think the foster care arrangement will improve the lives of your other children, you may circle more than one, if applicable: a) They will be less lonely; b) They will learn to be more accommodating: c) They will become more empathetic; d) Not applicable as I have no other children; e) Other, please specify ______________________________________ G. Attitude of grandparents/extended family members, other relatives and significant others towards the foster care: (Give a short description about the opinion of other important persons towards foster care who would have impact in the child rearing process)…………………………………………… 302 THE GAZETTE OF INDIA : EXTRAORDINARY [PART II—SEC. 3(i)] H. Anticipated Plans of the prospective foster parents for the child and rearing in the Family: (1) Please describe how you will manage caring for the child and other life commitments such as work. (2) Who will be responsible for caring for the child when you are at work, or absent from the familial home (domestic help, grandparents, spouse). (3) Please describe your disciplinary approach to parenting. (4) In case the foster child demonstrates adjustment difficulties, please describe the steps that you plan to take to ease his/her transition into the family? (5) Would you be prepared to utilize family counselling if the child continues to have difficulties adjusting? a) Yes b) No (6) Would you be willing to support financially higher professional studies of the foster child a) Yes b) No I. Preparation and Training: (Give details about the counselling sessions the prospective foster parent(s) have undergone on foster care, child care, handling of needs of children, etc. and their capacity, training and/or experiences in parenting children with their special need, if any) J. Health Status (Emotional and Physical): (Give details of the state of emotional and physical health status of the applicant(s), if any. If a family member suffers from a particular disease, condition or syndrome, describe how the family copes with it and how this might affect any proposed foster care.) (1) Do you or your spouse suffer from any medical condition? If so, would you please provide details? (2) Are you or your spouse currently being treated by a psychologist or psychiatrist? (3) Are you currently taking any prescribed medication? (4) Are there currently any child/ren in your house being treated for a medical condition? (5) Does your family have health and hospitalization insurance coverage for all family members? Signature of the Prospective Foster Parents Date PART-II: ASSESSMENT REPORT OF THE SOCIAL WORKER (To be used by the Social Worker to prepare the assessment report) (The information/facts filled in the template shall be kept confidential by the agencies /authorities.)