Application Forms
Cover Letter for Application Packet
Foster Care Provider Application
Background Check Form
Verification of Licensee Qualifications for TFC Providers
Health Check Form
Authorization for Release of Information Form
Mail your application to:
Samaritan Counseling Center
Treatment Foster Care
1478 Kenwood Dr. Suite 1
Menasha, WI 54952
CONTACT
If you would like more information on becoming a Treatment Foster Parent or a Respite Provider, please contact Treatment Foster Care Director Amy Falk at (920) 886-9319 ext. 109 or email her at
