How Much Do Host Home Providers Make in Colorado

This is a great opportunity for an adult community member to provide adult foster care services and support to individuals who desire to live in a family-like environment. The program allows for individuals from the community to accept 1 - 3 adults into their homes and provide residential services to them.  A daily reimbursement rate per individual is paid to the provider for services. Current Host Home Providers are paid an annual tax-free rate between $20,221.00 to $40,956.00 (depending on support level and the number of days in the month. Range of support may vary by individuals needs).

Host Home Provider Application and Profile

Located in La Junta, Colorado

Top Ten Reasons to Become a Host Home Provider:

1. Make a positive difference in someone's life
2. Supplement your income
3. Gain a fun and delightful live-in companion
4. Supported by a team of dedicated staff
5. Develop a life-long, rewarding relationship
6. 24-hour support for health services
7. Help others grow and discover their talents
8. Personal satisfaction of fulfilling dreams
9. Service contracted on a yearly basis
10. Great opportunity to learn new skills

This arrangement is bound by an independent contractor relationship between the community member and InspirationField in compliance with all Health Care Policy and Financing rules and regulations. The provider must meet all state and agency certification requirements. The range of care may vary from a moderate level of care to total care.

Host Home Provider Application and Profile

Name

First Name Last Name

Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

DO NOT GO ANY FURTHER IF YOU DO NOT LIVE NEAR LA JUNTA, COLORADO OR PLAN TO RELOCATE

Which county do you reside?

Please provide information about the individuals currently living in your home or who may be there while you are a Host Home Provider:

Name

First Name Last Name

Name

First Name Last Name

Name

First Name Last Name

Have you ever worked for Inspiration Field before?

• Yes
• No

If yes, please give dates:

Have you ever applied for a foster care license?

• Yes
• No

Are you currently licensed to provide day care or foster care in your home?

• Yes
• No

Are you currently providing day care or foster care to anyone in your home?

• Yes
• No

Have you ever been approved to provide Host Home services through any other agency?

• Yes
• No

If yes, please list agencies and dates of service:

Please provide your daily schedule, including hours worked and any on-going commitments (include classes, club meeting times, activities, etc.)

A CRIMINAL BACKGROUND CHECK IS REQUIRED OF ANY ADULT (Persons 18 or older) LIVING WITHIN THE HOST HOME

Have you or any member of your household been arrested for violations of the law other than minor traffic violations?

• Yes
• No

Have you or any member of your household been convicted of a felony or misdemeanor?

• Yes
• No

Are you or any member of your household currently on parole/probation?

• Yes
• No

Do you or any member of your household have a communicable disease?

• Yes
• No

EDUCATION, TRAINING AND SPECIAL SKILLS

What is the highest level of education you have completed?

Do you have any special certifications in related fields?

• Yes
• No

What is the primary language spoken in your home?

What other languages do you use fluently?

Are you proficient in sign language?

• Yes
• No

Employer's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Month/Year employment began:

Briefly describe your position and duties:

May we contact this employer?

• Yes
• No

Previous Employer's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Month/Year employment began:

Briefly describe your position and duties:

Previous Employer's Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Month/Year employment began:

Briefly describe your position and duties:

Please check the appropriate setting for your home below:

• House
• Apartment
• Townhouse/Condo
• Mobile Home
• Ranch
• Single-Story
• Two-Story
• Tri-Level

Location of available bedrooms:

Is your home wheelchair accessible?

• Yes
• No

What hours are you available to provide support services to persons living in your home?

Is any person currently living in your home receiving services from this or any other human service agency?

• Yes
• No

Please tell us about the people who may live with you, husband/wife, children, etc.:

I prefer to work with the following age group & people:

• Under 21
• 21-30
• 30-50
• Over 50
• No Preference
• Male
• Female
• No Preference
• One Person
• Two Persons
• Three Persons
• No Preference

I think I can accommodate an individual who:

• Smokes
• Has special diet needs or feeding/swallowing difficulties
• Uses a cane/walker/wheelchair
• Is unemployed or no longer working
• Has difficulty with stairs
• Has special behavioral needs or concerns
• Is non-verbal
• Is visually impaired
• Is hearing impaired
• Has special medical needs/concerns or needs special equipment
• Uses adult depends
• Uses sign language or needs communication device

Describe your interests that may take you away from the person(s) you will serve:

Who will assist you or provide care to the individual while you are away?

What are your plans for help during emergencies, holidays, vacations, days when Inspiration Field is closed, etc.?

Please note any pets that share your home:

Do you have any young children who frequently visit your home?

• Yes
• No

If yes, please give us their ages:

Please give us other information you would like considered when placing someone in your home:

Activities you frequently participate in or would be interested in sharing with individuals:

• Movies/TV/VCR
• Theater
• Concerts
• Travel
• Shopping
• Music
• Reading
• Crafts
• Sports
• Restaurant
• Hiking
• Bingo
• Jogging/Walking
• Camping
• Car Rides
• Swimming
• Photography
• Fishing
• Gardening
• Card Games
• Church
• Sewing
• Bowling
• Meetings & Clubs

Other activities you would like to engage in or share with the individual:

Please provide the following information for THREE non-relatives who know you well:

Name

First Name Last Name

Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Length of time they have known you

Name

First Name Last Name

Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Length of time they have known you

Name

First Name Last Name

Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Length of time they have known you

Do you know anyone currently providing services for our agency? If yes, who?

APPLICANT NOTE

This application form is intended for use in evaluating your qualifications to be an Independent Host Home Provider. This is not an employment contract. Please answer all questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the inquiry process or, if discovered after executing a contract, terminating that contract. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from consideration. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to execution of a contract.

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note above and that the answers given by me to the foregoing questions and to the statements made by me are complete and true to the best to my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or termination of contract at any time during the terms of the contract. I authorize the company and / or its agents including individual reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said person, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during the contract period.

Electronic Signature of Applicant

How Much Do Host Home Providers Make in Colorado

Source: https://www.inspirationfield.org/about-us/host-home-providers

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