Adopting Parents Application – Little Angel Adoptions

Name *

First

Last

One member of family please. You'll get a chance to name the second applicant in the application process.

Phone Number *

Email *

Confirm Email

State of Residence *

Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Applicant 1 Place Of Employment *

Applicant 1 Job Title *

Applicant 1 Work Phone *

Applicant 1 Work Address *

Applicant 1 Length Of Employment *

Applicant 1 Monthly Income *

Applicant 1 Health Insurance? *

Applicant 1 Life Insurance? *

Amount of Life Coverage (in $)

Is there a second applicant? *

Applicant 2

First

Last

Name of the second parent if applicable.

Applicant 2 Place Of Employment

Applicant 2 Job Title

Applicant 2 Work Phone

Applicant 2 Work Address

Applicant 2 Length Of Employment

Applicant 2 Monthly Income

Applicant 2 Health Insurance?

Applicant 2 Life Insurance?

Applicant 2 Amount of Life Coverage (in $)

Will either applicant continue to work after arrival of child? Please detail the plan to manage work and childcare needs if applicable. *

Applicant 1 DOB *

Applicant 1 Place Of Birth *

Applicant 1 - US Citizen? *

Applicant 1 - SSN *

This is only for background check purposes - omit dashes (just numbers)

Applicant 1 - Driver's License # *

Applicant 1 - Race / Nationality *

Applicant 1 - Religion *

Applicant 1 - Height *

Applicant 1 - Weight *

Applicant 1 - Hair/Eye Color *

Applicant 1 - Do You Use Alcohol? *

Applicant 1 - Ever Had A Problem With Alcohol? *

Applicant 1 - Do You Use Tobacco? *

Applicant 1 - Ever Had A Problem With Drugs? *

Applicant 2 Place Of Birth

Applicant 2 DOB

Applicant 2 - US Citizen?

Applicant 2 - SSN

This is only for background check purposes - omit dashes (just numbers)

Applicant 2 - Driver's License #

Applicant 2 - Race / Nationality

Applicant 2 - Religion

Applicant 2 - Height

Applicant 2 - Weight

Applicant 2 - Hair/Eye Color

Applicant 2 - Do You Use Alcohol?

Applicant 2 - Ever Had A Problem With Alcohol?

Applicant 2 - Do You Use Tobacco?

Applicant 2 - Ever Had A Problem With Drugs?

If you're married, please give the date and place of marriage

Please detail the children you currently have in your home, if any (Include name/birth/relationship/race etc.)

Please detail any past marriage details or any child support obligations and if you're current or not and why.

Tell us about your hobbies and talents *

Do either of you have any significant health issues? *

Have either of you ever been clinically depressed, given medication or hospitalized for depression or any other mental or emotional condition? If yes, please give details: *

Do either of you have any physical conditions or handicaps which will in any way affects your ability to parent? Please be specific. *

Have either of you had a convictions for crimes other than minor traffic violations? If yes, please explain. Was it a felony or misdemeanor? What was the crime and when did it happen: *

Describe Your Home, Backyard and Neighborhood *

Square Footage *

Number of Bedrooms *

Number of Bathrooms *

Do You Have Any Pets? If So, Tell Us About Them! *

Please Tell Us Why You Want To Adopt (Both applicants to write a paragraph) *

Describe the relationship you desire with an adopted child: *

Briefly describe any infertility problems you both may have had? *

How would your family feel about an adopted child? *

Applicant 1 Education - School *

Applicant 1 Education - Years Enrolled *

Applicant 1 Education - Degree & Date *

Applicant 2 Education - School

Applicant 2 Education - Years Enrolled

Applicant 2 Education - Degree & Date

Please let us know if either or both of you are religious and how faith will or will not impact your family and an adopted child. *

What potential situations are you open to? (Please check all that apply to your interests) *

New Born
Up to 3 mos.
3 - 6 mos.
6 mos. - 1 year
1 to 2 years
3 - 5 years
5+

What potential special situations are you open to? (Please check any that apply to your interests)

Special Needs Child
Sibling Group
Twins

What race/ethnicity are you open to? *

Caucasian
Hispanic
Asian
African-American
Native American
Hispanic / Cauc.
Hispanic / African-American
Hispanic / Asian
Asian / Cauc.
African-American / Cauc.
African-American / Asian
Native Amer./Other
Other

Gender Preference *

Boy
Girl
No Preference

Please describe worst case scenario of Birth Mother you would consider mother who:

(comment in each box)

Smoked cigarettes

Smoked marijuana

Used illegal drugs

Used Alcohol

Contact With Birth Mother & Child

Willing to have a close relationship during the pregnancy? *

Would like to be present at the birth? *

After the birth, are you willing to send the birth mother pictures and letters? *

What kind of post adoption contact with a birth mother are you open to?

What is your limit on birth mother expenses per month based on 5 months? Your situation may be different, but we need to know approximately how much support you can provide. *

$0 - $250
$250 - $500
$500 - $750
$750 - $1000
$1000 +

(This is for our information only to assist with matching you with your potential birth mother. We don’t want to send your resume to someone who needs more support than you can provide.. It will not be shared with anyone.)

Where did you hear about Little Angel Adoptions? *

Do You Have An Attorney? *

Attorney Name

First

Last

Attorney Phone Number

Are you signed up with any other consultants, organizations or agencies? *

Please provide names and contact details of other consultants, organizations or agencies.

Emergency Contact - Name *

First

Last

Emergency Contact - Phone *

Relationship of Emergency Contact *

Anticipated Timeline for Engaging Little Angels *

Now
1 - 3 Months
4 - 6 Months
Longer

Recent Photo For Profile *

Click or drag a file to this area to upload.

We hereby authorize Little Angel Adoptions to share some of the information on this questionnaire to any birth mothers who may be interested in working with us on an adoption plan and to any other professionals working on our behalf. We declare under penalty of perjury, under the law of the State of California, that the foregoing is true and correct.

Applicant 1 Signature *

Applicant 2 Signature