CATHOLIC CHARITIES OF SALINA, INC.
POLICE PROTECTIVE CUSTODY HOME APPLICATION
DATE: _____________________________
HUSBAND
Name: _______________________________________________________________________________
FIRST MIDDLE LAST
Date of Birth: _________________
Race: _________________ Ethnic background: ______________________________________________
Languages spoken______________________________________________________________________
WIFE
Name: _______________________________________________________________________________
FIRST MIDDLE LAST
Date of Birth: _________________
Race: _________________ Ethnic background: _____________________________________________
Languages Spoken_____________________________________________________________________
ADDRESS: _______________________________________________________________________________
Street or RFD City County State Zip
Home Phone Number (______) ____________________________
Husband's Cell Number (______) ____________________________
Wife's Cell Number (______) ____________________________
Email Addresses: _____________________________________________________________________
OTHERS IN HOUSEHOLD:
Name: _____________________________ Age ____ DOB ____________ Relationship _________________
Name: _____________________________ Age ____ DOB ____________ Relationship _________________
Name: _____________________________ Age ____ DOB ____________ Relationship _________________
HUSBAND PRESENT EMPLOYMENT:
Occupation ________________________________________________________________________
Employer __________________________________________________________________________
Telephone Number___________________________________________________________________
WIFE PRESENT EMPLOYMENT:
Occupation ________________________________________________________________________
Employer __________________________________________________________________________
Telephone Number___________________________________________________________________
DESCRIPTION OF HOME: (Rent/Own, # of bedrooms, etc.)_____________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
1. Why do you want to become a PPC Care Home? _______________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
2. What do you see as the primary need of a child who is in police protective care? How will you support those needs? ___________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
3. Describe the type of child will you accept for placement? (age, gender, characteristics, special needs)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
4. Describe the characteristics of children you feel would not be appropriate to be placed in your home.
_________________________________________________________________________________________
_________________________________________________________________________________________
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5. Discuss how you discipline children. How might your discipline differ for children in your home due to a PPC placement?
_________________________________________________________________________________________
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ANSWERS TO THE REQUIREMENTS 1) OCTOBER 1 2000 (WWWAMERICANCATHOLICORG)
APPENDIX L CATHOLIC PRAYER TRADITIONS FOR THE CATECHIST CATECHISTS
ARCHDIOCESE OF PHILADELPHIA OFFICE OF CATHOLIC EDUCATION 222 NORTH
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