Online Inquiry

Click the 'Generate Form' link to pre-populate the form when you are ready.

<ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Contact Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 100%;">
<i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">This form is for PTFFC (Pathways Treatment Family Foster Care) Program inquiries only.

If you would like to inquire about traditional Foster Care, Adoption, and Kinship, please return to our main page and click on Foster Care and Adoption Inquiry.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_A" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label required">First Name</label><input name="CST_1" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Name_Last_A">
<i class="fa fa-font"></i><label class="er_fld_label required">Last Name</label><input name="CST_2" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_B" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label required">Adult #2 First Name</label><input name="CST_3" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_Last_B">
<i class="fa fa-font"></i><label class="er_fld_label required">Last Name</label><input name="CST_4" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Phone_Home">
<i class="fa fa-font"></i><label class="er_fld_label required">Phone Number</label><input name="CST_11" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail">
<i class="fa fa-font"></i><label class="er_fld_label required">Email</label><input name="CST_12" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Home Address</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_1" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label required">Street Address</label><input name="CST_5" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_City" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_6" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Address_County">
<i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_7" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" map_to="FH_Address_State" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">State</label><select name="CST_8" class="er_fld_required"><option value="Alabama">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas" selected="">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Address_Zip">
<i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_9" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Inquiry Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" map_to="Location" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Which of our office locations is closest to your home?</label><select name="CST_10" class="er_fld_required er_fld_width100"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="DFW">DFW</option><option value="Houston">Houston</option><option value="San Antonio">San Antonio</option></select></li><li class="er_fld_type_dropdown er_fld_selected" draggable="false" map_to="FH_ReferralSource" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How did you hear about us?</label><select name="CST_13" class="er_fld_required"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Billboard">Billboard</option><option value="Church/Pastor">Church/Pastor</option><option value="Community Event">Community Event</option><option value="Community Impact Newsletter">Community Impact Newsletter</option><option value="DFPS/CPS">DFPS/CPS</option><option value="Display Table at Event">Display Table at Event</option><option value="Exceptional Kids Magazine">Exceptional Kids Magazine</option><option value="Facebook">Facebook</option><option value="Indeed">Indeed</option><option value="Instagram">Instagram</option><option value="Mailer/Postcard received in the mail">Mailer/Postcard received in the mail</option><option value="Movie Theatre/EVO Cinemas Creekside 14 New Braunfels">Movie Theatre/EVO Cinemas Creekside 14 New Braunfels</option><option value="Movie Theatre/Santikos Entertainment New Braunfels">Movie Theatre/Santikos Entertainment New Braunfels</option><option value="Neighborhood News">Neighborhood News</option><option value="News/TV">News/TV</option><option value="Other">Other</option><option value="Other Agency">Other Agency</option><option value="Pathways Employee">Pathways Employee</option><option value="Pathways Foster/Adoptive Parent">Pathways Foster/Adoptive Parent</option><option value="Pathways Newsletter">Pathways Newsletter</option><option value="Pathways Website">Pathways Website</option><option value="Radio">Radio</option><option value="Social Media">Social Media</option><option value="SSCC">SSCC</option><option value="Twitter">Twitter</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_type_radio_col1" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Interested In:</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_16" value="PTFFC (Pathways Treatment Family Foster Care)" checked="">PTFFC (Pathways Treatment Family Foster Care)</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_16" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_16_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false" map_to="FH_Inquiry_Why_Parents" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label required">Why do you want to be a Pathways Treatment Family Foster Care parent?</label><textarea name="CST_14" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false" map_to="FH_Inquiry_Comments" style="width: 50%;">
<i class="fa fa-paragraph"></i><label class="er_fld_label required">Do you have any questions or comments?</label><textarea name="CST_15" style="width:100%;" class="er_fld_required"></textarea></li></ul>