First name:
Last :
e-mail:
Address:
City:	. . State: . .
Zip:
Phone:
Birthday:	Month January Febuary March April May June July August September October November December
	Day. 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
	Year 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Gender:	Choose one female male
How long have you been in foster care?	Brand new . ...... Less than 6 mo . . 6 mo - 1 yr . . ... 1 yr - 3 yr . . more than 3 yrs
How did you find out about fyi3.com?	Internet . . Foster parent . . Caseworker . . independent Living Program . . Other:
Caseworker's name: