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    General Information

    Employment

    Household Composition

    Foster Care Information

    If you have ever been certified as a foster parent for another agency in this state or another state, provide the following information:

    Signature

    “I hereby certify that all of the above responses are true and correct. I understand that any false or misleading statements made as part of this application may be cause for non-acceptance into The Arc Northern Chesapeake Region’s Treatment Foster Care Program.”

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