Pitt County Forms Center

2.  
   
   
   

   1717 W. 5th Street Greenville, NC 27834  |  Telephone: (252) 902-1112

   Foster/Adoption Inquiry Form
    

4. Disclaimer

   Thank you for your interest in becoming a foster or adoptive parent for Pitt County Department of Social Services. If you are not currently licensed as a foster parent and are interested in obtaining additional information about our foster/adoptive parent program, please complete this inquiry form. After completing the inquiry form, you will receive a phone call from one of our foster/ adoptive parent recruiters within ten business days. 

   If you have any questions, 
   Call 252-902-1244 or email Chandra.Mewborn@pittcountync.gov.

6. Name
7. Email Address
9. Address
10. Apartment / Suite #
12. City
13. State
14. Zip Code
16. Phone Number
17. Fax Number
19. Gender

    1. Male
    2. Female
20. Date of Birth
    (mm/dd/yyyy)
21. Marital Status

    1. Married
    2. Single
    3. Divorced
    4. Widowed
    5. Domestic Partner
    6. Other
23. Other Family Members (18 years of age or older)
25. Name
26. Gender

    1. Male
    2. Female
27. Date of Birth
    (mm/dd/yyyy)
29. Name
30. Gender

    1. Male
    2. Female
31. Date of Birth
    (mm/dd/yyyy)
33. Name
34. Gender

    1. Male
    2. Female
35. Date of Birth
    (mm/dd/yyyy)
37. Name
38. Gender

    1. Male
    2. Female
39. Date of Birth
    (mm/dd/yyyy)
41. Name
42. Gender

    1. Male
    2. Female
43. Date of Birth
    (mm/dd/yyyy)
45. Interested In

    1. Foster
    2. Adoption
47. Comments
Leave This Blank:


49. Submit

* indicates a required field