First Name*
Last Name*
Street Address*
City
County*
State*
Zip*
Phone (with area code)*
Cell Phone
Email address
Secondary Email
Best way to contact
Family Race and Ethnicity*
What is your current age?*
Gender Identity:*
Relationship Status* Single Partnered
What type of care are you interested in providing?*
I'm interested in becoming a licensed Relative/Kinship caregiver.*
What encouraged you to inquire today?*
    If Other, please provide details:
What is your primary language

Once you submit your information, you will receive in-depth information via e-mail on the licensing process that will include important contacts within the Licensing Division available to assist with questions. Unfortunately due to COVID-19 impacts, DCYF is currently in between service providers to help provide individual support during this process. We hope this can be resolved soon. However, we still want to hear from you! Licensing Division remains fully operational and you are able to learn more and start the process.