There's no denying that the adoption process involves a lot of paperwork. If you are seeking the aid, advice, and counsel of an adoption attorney, he or she will guide you through the mountains of paper that lead to your child. In order to do so, you will need to provide your attorney with a vast amount of information. You can expedite the process by completing the following questionnaire before your first meeting with your lawyer.
| ADOPTIVE MOTHER | ADOPTIVE FATHER | |
| Name________________________________ | ______________________________ | |
| Date of Birth___________________________ | ______________________________ | |
| Social Security Number__________________ | ____________________ | |
Address, Including County |
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| Length of Time at that Address _______ years | _______ years | |
| Previous Address(es) (for last 10 years) | ||
| Home Telephone Number ____________________ | ____________________ | |
| Work Telephone Number ____________________ | ____________________ | |
| Facsimile Number ____________________ | ____________________ | |
| E-mail Address ____________________ | ____________________ | |
| Former Name(s) ____________________ | ____________________ | |
| ____________________ | ____________________ | |
| Employers ____________________ | ____________________ | |
| Position ____________________ | ____________________ | |
| Employer's Address | ||
| ______________________________ | ______________________________ | |
| ______________________________ | ______________________________ | |
| ______________________________ | ______________________________ | |
| Length of Time with Employer _______ years | _______ years | |
| Previous Employer(s) (for last 10 years) | ||
| ______________________________ | ______________________________ | |
| ______________________________ | ______________________________ | |
| ______________________________ | ______________________________ | |
| ______________________________ | ______________________________ | |
| Gross Monthly Income $_________________ | $_________________ | |
| Other Income | ||
| Source/Amount ________________________ | _________________________ | |
| Source/Amount ________________________ | _________________________ | |
| Source/Amount ________________________ | _________________________ | |
| Date of Marriage _________________________________ | ||
| Place of Marriage ________________________________ | ||
| Previous Marriage(s) Yes ____ No ____ | Yes ____ No ____ | |
| Ended by: | Ended by: | |
| Death ____ Divorce ____ Date ______ | Death ____ Divorce ____ Date _____ | |
| Death ____ Divorce ____ Date _____ | Death ____ Divorce ____ Date _____ | |
| Children of Current Marriage | ||
| Name Date of Birth | Adopted? Living in home? Race/Nationality | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| Children from Other Marriages or Relationships | ||
| Name Date of Birth | Adopted? Living in home? Race/Nationality | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
| _______________________ _________ | Yes/No Yes/No __________ | |
I/we am/are interested in (check all that apply): Domestic Adoption _____ Intercountry Adoption _____ Open Adoption _____ Closed Adoption _____ Infant Adoption _____ (under 12 months) Older Child _____ (state desired age range _____-_____) Sibling Groups _____ Do you have a gender preference? Yes, I/we prefer a ___________. No _____ State desired race or ethnicity of child(ren), if any. _____________________ If you are contemplating intercountry adoption, are there particular countries you are interested in? _______________________ I/we have the following amount available to fund the adoption (may affect options that can be pursued): Up to $1,000 _____ $1,000 to $5,000 _____ $5,000 to $10,000 _____ $10,000 to $20,000 _____ $20,000 to $30,000 _____ Over $30,000 _____ Do you have a completed home study? Yes _____ No _____ Has an adoption ever been denied to you? Yes _____ No _____ Have you ever been arrested? Adoptive mother: _______ Adoptive father: _______ If yes, explain: Are you in good health? Adoptive mother: ________ Adoptive father: _______ Explain all current and chronic illnesses, past and future surgeries, medications you are currently taking, and other relevant health information: Do you have a history of alcohol or drug abuse? Adoptive mother: ________ Adoptive father: ________ List three references who have known you for at least five years. Include a family member, a co-worker, and a social friend or neighbor. |
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| Name Address | Relationship How long known? | |
| ______________ ____________________ | _______________ ____________ | |
| ______________ ____________________ | _______________ ____________ | |
| ______________ ____________________ | _______________ ____________ | |
Other Important Information Questions to Ask My Attorney |
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