Adoption Application - legal forms

1 Adoption Application Family name: _____, Address: _____, County: _____, Home telephone _____, Rent _____, Own _____, Monthly payments _____, Mortgage value _____, Number of rooms _____, Number of bedrooms _____. Others in household: Name _____ Relationship _____ Age _____. Name _____ Relationship _____ Age _____. Marriage date: _____, Location: _____, License number _____. Have you, as a married couple, ever applied to adopt a child through another source? Yes _____ No _____. If yes, where did you apply? _____. Date applied _____ Status _____. Information pertaining to husband: Name: First _____, Middle _____, Last _____. Birth date _____, Birth place _____, Race _____. Nationality _____, Citizenship _____, Religion _____. Physical description: Height _____, Weight _____, Hair color _____, Eye color _____, Complexion _____.

2 Education: Name and location of high school _____. Date and grade of high school completed _____. Same information for any college _____, Degree _____. Employment: Company name _____, Address _____, Telephone number _____, Date begun _____, Annual salary _____, Work hours _____, Position title _____, Type of work _____, Social Security number _____. If you were in the Armed Forces, please give number _____. Were you ever previously married? Yes _____, No _____, When _____, Where _____, Former spouse's name _____, Date marriage terminated _____, Where _____, By: Divorce? _____, Who filed? _____, Death? _____. Information pertaining to wife: Name: First _____, Middle _____, Last _____. Maiden name _____, Previous married names _____. Birth date _____, Birth place _____, Race _____.

3 Nationality _____, Citizenship _____, Religion _____. Physical description: Height _____, Weight _____, Hair color _____, Eye color _____, Complexion _____. Education: Name and location of high school _____. Date and grade of high school completed _____. Same information for any college _____, Degree _____. Employment: Company name _____, Address _____, Telephone number _____, Date begun _____, Annual salary _____, Work hours _____, Position title _____, Type of work _____, Social Security number _____, number _____. Were you ever previously married? Yes _____, No _____, When _____, Where? _____, Former spouse's name _____, Date marriage terminated _____, Where _____, By: Divorce? _____, Who filed _____, Death? _____. Financial information: Please attach a separate page listing stocks, bonds interest from savings or any other income or assets (please be specific with names and amounts), all debts and liabilities, all insurance policies (please give company name, what type of insurance, who is insured, amounts of coverage and name of beneficiary).

4 Emergency contact: Name _____, Relationship _____, Address _____, Telephone numbers (Day) _____(Evening), _____. Please attach to your Application , a recent photograph of family members: Husband, Wife, Child or Children (Polaroid photographs are acceptable).