Child-Focused Care Application

NOTE: This application is for CHILDREN 6-17 needing placement. If you are a single mother with children needing family care assistance, please use this form instead: http://bit.ly/OBHC-FamilyApp. Thank you.

Location Preference

By checking your placement location preference below we will know how to best direct your application.

Please do not submit an application to multiple locations. If you select "No Location Preference/First Available," your application will automatically be routed to both locations accepting your child's gender.

Legal Custody/Guardian Information
Who has legal custody of the child?

Child Information

Please note - information in this section and from here on is about the child - not the person filling out the application. Thank you!

Emotional Issues

Suicidal Thoughts

As a courtesy, we would like to notify you of the initial status of your application. This is optional and is just our way of keeping you informed of the process. Once the campus reviews your application, they will be contacting you. If you would like us to let you know of the initial status of processing, please indicate your preference.