Fostering Application Form

Tel: 6354 8799 Fax: 6385 1054 Email: [email protected]

Dear Sir/Madam,

Thank you for your interest in joining the MSF Fostering Scheme!

2. Please find attached the respective Fostering application forms:

a) Fostering Application Form b) Self-Declaration Forms for both applicants c) Form for Character Referees*

3. We would appreciate if you can furnish us a copy of the latest payslip of the main income earner in your household. An Employment Letter or Income Tax Return Form may also be provided if payslip is unavailable. You will be able to download your income tax information at the IRAS portal (https://mytax.iras.gov.sg/) using your Singpass.

4. Please forward us your completed application form, character referee form and copy of payslip to us by email or by post. Our contact details are provided below.

5. Kindly rest assured that all documents received will be treated as strictly confidential and used for the sole purpose of your application to be foster parents.

6. We will get in touch with you within 3 days of receiving your application form For more information or any enquiries, please contact the MSF Fostering Services at the following:

Website: www.msf.gov.sg/fostering Hotline: 6354 8799 Address: 512 Thomson Road, #11-00, MSF Building, Singapore 298136 Email: [email protected]

7. Thank you and we look forward to receiving your application soon.

Yours faithfully,

MSF Fostering Service Children in Care Service Rehabilitation and Protection Group Ministry of Social and Family Development MINISTRY OF SOCIAL AND FAMILY DEVELOPMENT CHILDREN IN CARE SERVICE FOSTERING SERVICES MSF FOSTERING SCHEME: APPLICATION FORM FOR FOSTER PARENTS

1 PERSONAL PARTICULARS (FEMALE APPLICANT) Full name (Block Letters) Telephone no. Home:

Office: NRIC/FIN: Hp:

Date of Birth: Age:

Home Address Email Address

Ethnic Group Religion Monthly Income ($): Chinese Christianity <2,000 Malay Islam 2,000 to 4,000 Indian Buddhism 4,000 to 6,000 Eurasian Taoism 6,000-8,000 Others, please specify Hinduism >8,000 Others, please specify: Not Applicable

Highest Educational Level Language Primary Mandarin: Spoken / Written Secondary Post Secondary Malay: Spoken / Written Diploma Tamil: Spoken / Written Degree Post graduate diploma English: Spoken / Written Masters PhD Others, please specify: Others, please specify:

2 PERSONAL PARTICULARS (MALE APPLICANT) Full name (Block Letters) Telephone no. Home: NRIC/FIN: Office:

Hp: Date of Birth: Age:

Home Address (As indicated above ) Email Address

Ethnic Group Religion Monthly Income ($): Chinese Christianity <2,000 Malay Islam 2,000 to 4,000 Indian Buddhism 4,000 to 6,000 Eurasian Taoism 6,000-8,000 Others, please specify Hinduism >8,000 Others, please specify: Not Applicable

Highest Educational Level Language Primary Mandarin: Spoken / Written Secondary Post Secondary Malay: Spoken / Written Diploma Tamil: Spoken / Written Degree Post graduate diploma English: Spoken / Written Masters PhD Others, please specify: Others, please specify:

3 INFORMATION ON CHILDREN OF APPLICANTS LIVING IN THE SAME HOUSEHOLD Name (as per NRIC/ Birthcert) Sex ID Number Age Name of School / Occupation

3 INFORMATION ON CHILDREN OF APPLICANTS LIVING IN THE SAME HOUSEHOLD Name (as per NRIC/ Birthcert) Sex ID Number Age Name of School / Occupation F / M

4 INFORMATION ON OTHER MEMBERS IN THE HOUSEHOLD (Including tenants and domestic helpers) Name (as per NRIC/ Birthcert) Sex ID Number Age Name of School/ Occupation F / M

5 PREFERRED FOSTER CHILD (You may tick more than one box) Age Under 1 year 1 year – 3 years 4 years – 6 years Male

Female

Are you open to caring for a child with special needs? Yes No

Other remarks

6 EXPERIENCE IN CARING FOR CHILDREN Do you have any experience in working with or caring for children? Yes No

Please elaborate:

7 HOUSING Housing type: Ownership Status: Is your home fixed with window grilles for all windows and balconies? 1 room HDB Rented 3 room HDB Purchased Yes No 4 room HDB Others, please specify: 5 room HDB If No, are you prepared to install window grilles for all your windows and balconies? Executive Condo Yes No Private Condo Landed property Kindly note that window grilles are mandatory for foster children aged 1 – 12 years old. Others, please specify:

Number of bedrooms:

8 HOUSEHOLD INCOME Combined net monthly household income (S$)

9 OTHER MATTERS How did you find out about the Fostering Scheme? (You may tick more than one) Fostering Agencies MCYC Boys’ Town

Mass Media News articles Please specify: Radio Please specify: Television Please specify: Website Please specify:

Community agencies (e.g. VWOs, NGOs, Government Ministries, Healthcare Agencies, Religious Organisations etc):

Please specify:

Fostering road show / event

Venue: Date:

Referred by foster parent.

Name of foster parent:

Referred by non – foster parent. (Please indicate relationship with referee)

Relationship:

Other channels

Is there any other information that you would like to share with us?

What inspired you to be a foster parent? To have companionship for our children We love children and want to help vulnerable children As a form of community service Others, please specify:

MINISTRY OF SOCIAL AND FAMILY DEVELOPMENT FOSTERING SERVICES / CHILDREN IN CARE BRANCH SELF – DECLARATION FORM (FEMALE

Please answer the following Yes No questions by ticking “Yes” or “No” as appropriate.

Have you OR any of your household and immediate family members 1 Ever been convicted in a court of law in Singapore or any other country?

If yes, please specify:

2 Ever been subjected to any pending prosecutions in Singapore or any other country?

3 Ever been issued with any warning(s) by the Police in Singapore or any other country?

4 Ever committed any offence involving violence of any nature or drug-related offence in Singapore or any other country?

5 Ever been remanded in prison in Singapore or any other country?

6 Previously known to the Ministry of Social and Family Development?

7 Ever suffered or are suffering from any mental illness? If yes, please specify:

8 Ever been referred to the Probation Services Unit?

9 Ever been involved in care proceedings or in a child protection investigation or enquiry in Singapore or any other country?

10 Previously or currently known to the Family Court for Personal Protection Order/ Expedited Order or family violence issues in Singapore or any other country?

11 Ever been financially embarrassed and undergone any bankruptcy proceedings?

□ I understand that MSF and MSF-appointed agencies require our personal information for the purpose of assessing our application for the Fostering Scheme. We understand that this information will not be shared with other agencies or organisations. □ I hereby declare that all the information that we have given on this form is true and accurate. We understand that knowingly giving false information or omitting information could affect our application to be Foster Parents.

Name: Date:

SELF – DECLARATION FORM (MALE APPLICANT)

Please answer the following Yes No questions by ticking “Yes” or “No” as appropriate.

Have you OR any of your household and immediate family members 1 Ever been convicted in a court of law in Singapore or any other country? If yes, please specify:

2 Ever been subjected to any pending prosecutions in Singapore or any other country?

3 Ever been issued with any warning(s) by the Police in Singapore or any other country?

4 Ever committed any offence involving violence of any nature or drug-related offence in Singapore or any other country?

5 Ever been remanded in prison in Singapore or any other country?

6 Previously known to the Ministry of Social and Family Development?

7 Ever suffered or are suffering from any mental illness?

8 Ever been referred to the Probation Services Unit?

9 Ever been involved in care proceedings or in a child protection investigation or enquiry in Singapore or any other country? If yes, please specify:

10 Previously or currently known to the Family Court for Personal Protection Order/ Expedited Order or family violence issues in Singapore or any other country?

11 Ever been financially embarrassed and undergone any bankruptcy proceedings?

□ I understand that MSF and MSF-appointed agencies require our personal information for the purpose of assessing our application for the Fostering Scheme. We understand that this information will not be shared with other agencies or organisations. □ I hereby declare that all the information that we have given on this form is true and accurate. We understand that knowingly giving false information or omitting information could affect our application to be Foster Parents.

Name: Date:

The Personal Data Protection Act (PDPA) protects your personal data while enabling organisations to use your data reasonably to serve you. We, as a government institution, respect and keep your data safe by limiting access to authorised personnel and using it for the sole purpose of publicity of the Fostering Scheme.

Character Referees for Application to be Foster Parents (Referees should not be members of the family. They should be above 25 years old and have known the Applicant for at least 3 years) ______Referee 1

Name: ______NRIC: ______Age: _____

Address: ______Postcode: ______

Contact number(s): ______Occupation: ______

Relationship to Applicant: ______No. of years having known Applicant: ______

Referee 2

Name: ______NRIC: ______Age: _____

Address: ______Postcode: ______

Contact number(s): ______Occupation: ______

Relationship to Applicant: ______No. of years having known Applicant: ______

Name of Applicant : ______

NRIC No. : ______

Applicant’s signature : ______

Date : ______