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Form 1173-2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin with Section A, where you will enter your personal information. Fill in your name, date, address (including street or P.O. Box, county, city, state, and zip code), and specify the number of children you plan to care for along with their age range.
  3. In Section A, ensure you provide your signature and if applicable, the signature of your partner.
  4. Move to Section B for agency recommendations. Enter the name and address of the agency that has evaluated your home. Confirm that the home is suitable for fostering by checking the appropriate status box.
  5. Finally, in Section C, record the license number and number of children approved. Ensure that this section is signed by the Director of Human Services or their designee.

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