AFC Caregiver Application

Thank you for your interest in becoming an Adult Family Care (AFC) Caregiver. Please review the enclosed information and return the required paperwork to Tri-Valley’s AFC Department.

As part of the approval process, prospective caregivers are required to have a physical exam and a tuberculosis test (PPD) within the past year. If you have not had a physical or TB test, please schedule these as soon as possible. Documentation of both a physical exam and TB test must be provided to the AFC assessment team prior to your enrollment in the program. Once we receive the required documentation, we will schedule an assessment visit where an AFC RN and AFC Case Manager will come to your home.

During this visit, assessments will be completed to determine your eligibility as a caregiver. Smoke detectors, carbon monoxide detectors, and a working fire extinguisher are required to approve the home so please ensure you have these prior to the assessment visit. Criminal background checks (CORI) and Sex Offender Registry checks (SORI) will be obtained for everyone residing in the home over the age of 18.

Upon completion of the application process and caregiver training, you will be notified of your status as a qualified AFC caregiver. If you are a relative of a potential member, we will also be working to obtain approval for that person to enroll in the AFC program. Potential members are required to have both a physical exam and a tuberculosis test (PPD) within the past year as well as an office visit within the past 3 months.

Again, thank you for your interest in the AFC program. If you have any questions, feel free to contact us directly at (508) 949-6640.

View Tri-Valley Inc.'s Adult Family Care Information Sheet for Potential Caregivers