ERIKA – Oregon Community Programs

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Services
Foster Care
About Us
Careers
Contact Us

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Oregon Community Programs

A private nonprofit agency providing research-based treatment and prevention services to children, youth, and families since 1983.

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Services

Mental Health
Early Childhood
Connections Program
In-Home Behavioral
Support Groups

Foster Care

Foster a Child
Certification
Respite Care
FAQs
QUEST Program

Organization

About OCP
Our Team
Board of Directors
Careers
Newsletter

Mon–Fri 9am–6pm · 1170 Pearl St., Eugene OR 97401

Name *

First

Last

Email *

Phone *

Preferred Method of Contact *

Phone
Text
Email

What city are you located in? *

I'm interested in: *

Full Time Fostering
Respite/Weekend Fostering
More Information

Check all that apply

I'd be open to fostering:

LGBTQIA+ and/or Gender Expansive Youth
Adjudicated Youth (Oregon Youth Authority)
BIPOC Youth (Black, Indigenous, People of Color)
Native/Indigenous Youth
Youth that use English as a second language

Check all that apply

The age range that I'm most interested in fostering is:

6-11 years old
12-18 years old
No Preference

Check all that apply

interested be Message

Your Message

How did you hear about us?

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Your Name *

First

Last

Your Email *

FRIEND’s name *

First

Last

FRIEND’s phone number *

Friend’s Email address *

Are you filling this out for yourself/your child *

Yes
No

Provide your relationship to the child and contact information for yourself. *

Name *

First

Last

Caregiver/Parent Name *

First

Last

Caregiver/Parent Phone *

Caregiver/Parent Email *

Child's Name *

First

Last

Child's Date of Birth *

Child's Age *

Physical Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (If different from Physical Address)

Address Line 1

Address Line 2

City

State

Zip Code

this relationship Insurance

Insurance

My child has Oregon Health Plan (Add ID # below)
My child is uninsured or has commercial insurance

OHP ID #

Not required if child is uninsured or has commercial insurance

Are you seeking services for any of the following?

Non Compliance
Social Skills
Aggression
Academic Difficulties
Depression
Adjustment Difficulties
Problems with Peers
Anxiety
Grief
Separation Anxiety
Emotional Regulation
Difficulty with transitions
Specific traumatic event
Other

Other

Is there anything else you'd like us to know?

Ex: previous treatments or hospitalizations, diagnosis, previous providers, caseworker information, etc.

Are you interested in receiving information about a specific program?

Early Childhood (ages 0-7)
Connections (ages 7-18)
Parenting Through Change (PTC)
Parent Child Interaction Therapy (PCIT)
Parent/Toddler Workshops

How did you hear about OCP?

Name *

First

Last

Email *

Phone *

Preferred method of contact *

Phone Call
Text
Email

Message: *

Location (City or County)

did Preferred Email

How did you hear about us?