Adoption Application For Married Heterosexual Couple
This form is an application for a married heterosexual couple wanting to adopt a new child into their lives. The form provided here is simply a basic structure for what you may need to actually have in order to adopt a child in your given state. However, this give you a good idea what you might need to fill out when you adopt.
Adoption Application For Married Heterosexual Couple
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 _________
Education:
Name and location of high school _________.
Date and grade of high school completed _________.
Same information for any college _________
Degrees Received _________.
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 A.F. number _________.
Were you ever previously married?
Yes _________ No _________
When _________
Where _________
Former spouse's name _________
Date marriage terminated _________
Where _________
Cause: Circle One: Divorce/Death/Other:_________
Who filed? _________
Information pertaining to wife:
Name:
First ___________
Middle _________
Last ___________
Birth date _________
Birth place _________
Race _________
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 _________
Degrees Received _________.
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 A.F. number _________.
Were you ever previously married?
Yes _________ No _________
When _________
Where _________
Former spouse's name _________
Date marriage terminated _________
Where _________
Cause: Circle One: Divorce/Death/Other:_________
Who filed? _________
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).
Emergency contact:
Name: _________
Relationship: _________
Address: _________
Telephone (Day): ________________ (Evening): __________________.
Please attach to your application, a recent photograph of family members: Husband, Wife, Child or Children (Polaroid photographs are acceptable).