Kinship Foster to Adopt and Adoption

Home Development Expense Stipend Application

Applicant’s Name: ______Date of Application: ______

Home Address: ______Phone Number: ______

Circle One: Adoption Foster to Adopt DFPS Caseworker’s Name: ______

Stipend Request

  Approved

  Partial Approval

  Denied

Reason for denial: ______

______

Kinship ADOPTION Home Development Expenses

Please check the items you need MFS to cover for the cost of your home development process

Ö  / Item/Cost/Description / Quantity / Cost / Approved/Denied
5lb Fire Extinguisher /$18.00 per item/1 per floor is needed
Fire Escape Ladder / $35.00 per ladder /Two story or higher level apartments ONLY
Medication Lockbox/ $10.00 each/ One lockbox per person on medication including children
First Aid Kit/ $5.00 / 1 per household
FBI Fingerprints / $37.25 per person/ Household member (s) over the age of 14 years old must have FBI fingerprints completed
TB Test / $35.00 per person / Household member over the age of 1 years old (including child/children being adopted) must have TB test
Other home development needs (list): ______
______

Total Approved Amount: ______

Kinship FOSTER TO ADOPT Home Development Expenses

Please check the items you need MFS to cover for the cost for your home development process

Ö  / Item/Cost/Description / Quantity / Cost / Approved/Denied
5lb Fire Extinguisher /$18.00 per item/1 per floor is needed
Fire Escape Ladder / $35.00 per ladder /Two story or higher level apartments ONLY
Medication Lockbox/ $10.00 each/ One lockbox per person on medication including children
First Aid Kit/ $5.00 / 1 per household
FBI Fingerprints / $37.25 per person/ Household member(s) over the age of 14 years old must have FBI fingerprints completed
TB Test / $35.00 per person / Household member over the age of 1 years old (including child/children being adopted) must have TB test
Mattress Covers /$8.00 per cover / Each bed the child or children sleep will need a mattress cover
Gas Pressure Test / $85 – $250 (based on the area of the home) / Secure 3 quotes
Air Condition System Check /$150.00
Electrical Inspection /$365.00
Environmental Inspection / $50 – $150 (based on the area of the home/ Secure 3 quotes
Water Test / $20.00 / Private Wells ONLY
Fire Inspection / $50.00 / Conducted by Fire Marshall ONLY
Other home development needs (list): ______
______

Total Approved Amount: ______

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