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Friday25 April 2014

Family Profile
  1. PART I: IDENTIFYING INFORMATION
    1. Service Type (select one)
    2. If Parent Initiated, please provide details of your request including the country of adoption, if a specific child has been identified, and if that child is already known to or related to you.
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    3. Husband or Single Applicant
    4. First Name(*)
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    5. Last Name(*)
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    6. Date of Birth (mm-dd-yyyy)(*)
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    1. Wife or Partner
    2. First Name
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    3. Last Name
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    4. Date of Birth (mm-dd-yyyy)
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  2. Date of Marriage (mm-dd-yyyy)
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  3. Address(*)
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  4. City(*)
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  5. State(*)
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  6. Zip code(*)
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  7. Phone Number (xxx-xxx-xxxx)(*)
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  8. Preferred Email(*)
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  9. List All Children in Family
  10. Child 1 - Name
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    1. Date of Birth (mm-dd-yyyy)
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    2. Gender
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    3. In family via:
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  11. Child 2 - Name
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    1. Date of Birth (mm-dd-yyyy)
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    2. Gender
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    3. In family via:
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  12. Child 3 - Name
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    1. Date of Birth (mm-dd-yyyy)
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    2. Gender
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    3. In family via:
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  13. Child 4 - Name
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    1. Date of Birth (mm-dd-yyyy)
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    2. Gender
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    3. In family via:
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  14. If you have more than 4 children in the home, please provide additional details (Name, DOB, gender, birth or adoption)
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  15. Do you have a current homestudy?
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  16. If yes, what are you approved for? (country, ages, # of children)
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  17. Optional Questions: The following questions are more personal but will help determine country eligibility
  18. Has either parent ever been divorced?
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  19. Does either parent have a past or current medical condition or diagnosis?
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  20. Is either parent currently on medication?
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  21. Has either parent ever been arrested?
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  22. Please feel free to provide additional information about any YES answer:
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  23. PART II: CHILD(REN) PREFERENCES
  24. Could you adopt a child of either gender?
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  25. If NO, please explain:
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  26. What age child could you consider parenting? (youngest age / oldest age)
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  27. Could you adopt biological siblings?
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  28. If YES, please indicate how many children:
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  29. What parts of the world could you adopt from? (check all that you could consider)
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  30. If there is a specific waiting child or specific children you are interested in adopting, please list the name(s):
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  31. If you could parent a child with a medical need, please answer the following questions.
    NOTE: This does not obligate you in any way. We know that whether or not you could actually adopt a child will depend upon an evaluation of all of the factors in a child's life.
  32. Could you consider... (check all that you could consider)










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  33. Comments
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