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Youth in Texas for the National Independent Living Conference

September 1, 2011

Brittany and her fellow Independent Living youth are having an amazing experience in Texas:

[youtube]http://www.youtube.com/watch?v=BzZBtLfN9BI[/youtube]

PrevPreviousSisters and brother adopted

NextCHOICES Youth meet NBA Star Jason TerryNext

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DAYTON:

1785 Big Hill Road Dayton,
Ohio 45439

CINCINNATI:

4010 Executive Park Dr.
Suite 330 Cincinnati, OH 45241

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Dayton: (937) 264-0084
Cincinnati: (513) 521-8111
info@choicesohio.org

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Visit GuideStar.org to view CHOICES, Inc.’s Form 990

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Prospective Parents SACWIS Information Form

*Must be completed before beginning the first training session with CHOICES, Inc.
Information listed below is for the sole purpose of CHOICES, Inc. entry of your information into Statewide Automated Child Welfare Information System (SACWIS).

Prefix

First Name

Middle Name

Last Name

AKA’s, including maiden names

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Home Phone

Cell Phone

DOB

SSN

Gender

Driver’s License #

State

Exp. Date

Race

I have parented for 5 or more years

Are you interested in Fostering ONLY or Fostering & Adoption?

Email Address *

Consent *

I herby acknowledge that the information provided by me is accurate and complete.

X

X