APPLICATION FOR ADOPTION SERVICES
Applications are valid for one year from date of receipt
NOTE: Omission of data may extend the approval process.
Intercountry Adoption and Placement Services (Check all that apply)
Home Study Services
Full Legal Name Same as Passport
PROSPECTIVE ADOPTIVE PARENT INFORMATION
Prospective Adoptive Father
Prospective Adoptive Mother
List all of your children and other persons living in your home; include relatives, boarders, roommates, and employees. For adopted children, include country.
GENERAL HEALTH & OTHER INFORMATION
Have you had a history of alcohol or substance abuse?: