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Adopting Parents Application
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Basic Details
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Step
1
of 8
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
*
Email
Confirm Email
State of Residence
*
Choose Your State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Start Full Application Now
Home Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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?
*
Yes
No
Applicant 1 Life Insurance?
*
Yes
No
Amount of Life Coverage (in $)
Is there a second applicant?
*
Yes
No
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?
Yes
No
Applicant 2 Life Insurance?
Yes
No
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.
*
Previous
Move On To Vital Statistics Section
Applicant 1 DOB
*
Applicant 1 Place Of Birth
*
Applicant 1 - US Citizen?
*
Yes
No
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?
*
Yes
No
Applicant 1 - Ever Had A Problem With Alcohol?
*
Yes
No
Applicant 1 - Do You Use Tobacco?
*
Yes
No
Applicant 1 - Ever Had A Problem With Drugs?
*
Yes
No
Applicant 2 Place Of Birth
Applicant 2 DOB
Applicant 2 - US Citizen?
Yes
No
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?
Yes
No
Applicant 2 - Ever Had A Problem With Alcohol?
Yes
No
Applicant 2 - Do You Use Tobacco?
Yes
No
Applicant 2 - Ever Had A Problem With Drugs?
Yes
No
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.
Previous
More About You
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!
*
Previous
More About Why You're Wanting To Adopt
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.
*
Previous
Your Preferences
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
Previous
Move To Birth Mom Preferences
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?
*
Yes
No
Would like to be present at the birth?
*
Yes
No
After the birth, are you willing to send the birth mother pictures and letters?
*
Yes
No
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.)
Previous
On To Final Steps
Where did you hear about Little Angel Adoptions?
*
Google Search
Referral From Social Worker
Radio Ad
Social Media
Word Of Mouth
Returning Parent
Mailer
Other
Do You Have An Attorney?
*
Yes
No
Attorney Name
First
Last
Attorney Phone Number
Are you signed up with any other consultants, organizations or agencies?
*
Yes
No
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
*
Clear Signature
Applicant 2 Signature
Clear Signature
Previous
Comment
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