VISITING RESOURCE CORI REQUEST FORM

Foster Home Information:

Family Net ID#:

 

1. 

Foster Parent Name:

 

2.

Foster Parent Supervisor/Foster Care Clinician:

 

 

 

 

Primary Visiting Resource Information:

1.

Name:

 

2.

Gender:

 

3.

Address:

 

4.

Date of Birth:

 

5.

Place of Birth:

 

6.

Social Security #:

 

7.

Occupation:

 

8.

Relationship to Foster Parent:

 

9.

Signature:

 

 

Additional Visiting Resources (only if at same address as primary visiting resource):

 

Name

SSN

DOB

M/F

Relationship

Signature

1.

 

 

 

 

 

 

2.

 

 

 

 

 

 

3.

 

 

 

 

 

 

4.

 

 

 

 

 

 

5.

 

 

 

 

 

DO NOT WRITE BELOW THIS LINE – FOR OFFICE USE ONLY

RECORD OF CORI

Date Received:

 

Signature:

 

Date Entered:

 

Signature:

 

Date Looked Up:

 

Signature:

 

 

CORI RESULTS

Primary Visiting Resource

Result

Approved?

Letter Sent to FP?

Staff Notified?

 

 

 

 

 

Household Members

Result

Approved?

Letter Sent to FP?

Staff Notified?

1.

 

 

 

 

 

2.

 

 

 

 

 

3.

 

 

 

 

 

4.

 

 

 

 

 

5.

 

 

 

 

 

VISITING RESOURCE CORI REQUEST FORM INSTRUCTIONS

 

Foster Home Information:                                                          (leave Family Net ID# blank)

1.       Fill in the name of the foster parent you wish to e a visiting resource for.

2.       Fill in the name of the foster parent supervisor or the foster care clinician for the child placed in the home (the foster parent will have this information).

Primary Visiting Resource Information:

1.       Fill in your full legal name (include maiden name if applicable).

2.       Specify your gender.

3.       Fill in your current address (include street, city, state and zip code).

4.       Fill in your date of birth (include month, day and year).

5.       Fill in the city and state of your birth (include country if not the United States ).

6.       Fill in your nine-digit social security number.

7.       Fill in your current occupation.

8.       Fill in your relationship to the foster parent (i.e. is the foster parent your sister, friend, cousin, daughter, etc.)

9.       Sign your full name on this line.  This gives authorization for the CORI to be completed.

 

Additional Visiting Resources:

This section may only be used for people living at the same address as the primary visiting resource listed. 

If they live at a different address, a separate form must be used.

 

Fill in the name, social security number, date of birth, gender (male/female), and relationship to foster parent.  Each additional visiting resource must sign on the line with the information. 

A parent or legal guardian must sign for those under the age of 18.

VISITING RESOURCE INFORMATION

Thank you for your interest in becoming a visiting resource for a child in our program.  This section is intended to answer questions you may have about the process of becoming a visiting resource.  If you have additional questions, please call Elizabeth Mello at 508-821-7774.

 

Frequently Asked Questions:

1.       What is a visiting resource?

A visiting resource is an adult over the age of 18 (who is not a foster parent with our program) who spends time with a child placed in our program.  Visiting resources may take a child on an outing or may “baby-sit” the child for the foster parent.  Please note that visiting resources cannot supervise children overnight.

 

2.      How do I become a visiting resource?

        You must fill out a Visiting Resource CORI Request Form and be approved by the program.  These forms are available from our foster parents.

 

3.      What is a CORI?

A CORI is a criminal record background check that also documents any involvement you have had with the Department of Social Services.

 

4.      What kid of information shows up on a CORI?

All criminal arrests and charges (including disorderly conduct, failure to appear in court, attaching wrong places, etc.) will show up on the CORI.  Any current or previous restraining orders will be reported.  If you were ever on probation, this will also be reported.  In addition, any involvement with the Department of Social Services (DSS) will be reported.  If you have ever been a foster parent, requested services from DSS or have had a 51-A (child abuse and neglect) report filed on you, this will be included in the CORI.

 

5.      Who will have access to this information?

Specialized foster care staff that is working directly with the foster parents and child will be informed of the results of the CORI.  This information is kept in the strictest of confidence and is only used in determining your eligibility in being approved as a visiting resource.  Foster parents are only informed of your approval or denial as a visiting resource.

 

THE RESULTS OF YOUR CORI WILL NOT BE RELEASED TO THE FOSTER PARENTS, FOSTER CHILDREN OR ANY OTHER PARTY OUTSIDE OF THE SPECIALIZED FOSTER CARE PROGRAM.