Apply for Adoption | Adoption Advocates Inc

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Name of Applicant 1

Applicant 1 Date and Place of Birth

Name of Applicant 2

Applicant 2 Date and Place of Birth

Present Address

How long have you lived there?

Telephone (Home)

(Work)

Applicant 1 Email

Applicant 2 Email

Previous Address

How long did you live there?

Present Marriage (When)

(Where)

Children of Present Marriage: (Name, Age, Natural Or Adopted)

Previous Marriages: To Whom/Where/When Ended

Previous Marriages: To Whom/Where/When Ended

Applicant 1

Applicant 2

Children of Previous Marriage: (Name and Age)

Personal Data: Applicant 1/ Applicant 2

Citizenship

Religion

Height

Weight

Hair Color

Eye Color

Applicant 1 Education

High School

Some College

Other School

College

Name/Address

Dates Attended

Major

Degree

Date of Graduation

Applicant 2 Education

High School

Some College

Other School

College

Name/Address

Dates Attended

Major

Degree

Date of Graduation

Medical History: Applicant 1

Medical History: Applicant 1

Diagnosis/Treatment

Dates

Medical History: Applicant 2

Medical History: Applicant 2

Diagnosis/Treatment

Dates

Employment: Applicant 1

Present Employer

Date

Position

Prior Employer

Date

Position

Employment: Applicant 2

Present Employer

Date

Position

Prior Employer

Date

Position

Military Service

Military Service

Applicant 1

Applicant 2

Arrests (Full Details Excluding Minor Traffic Violations) Applicant 1

Arrests (Full Details Excluding Minor Traffic Violations) Applicant 2

Insurance

Accident

Health

Life

Personal References (please list 3)

Name 1

Address 1

Phone 1

Name 2

Address 2

Phone 2

Name 3

Address 3

Phone 3

Other Persons Residing in Your Home

Other Persons Residing in Your Home

Name(s)

Age

Relationship

NOTE: IN ORDER TO PROCESS THIS APPLICATION, WE WOULD APPRECIATE ANSWERS TO THE FOLLOWING PERSONAL QUESTIONS

NOTE: IN ORDER TO PROCESS THIS APPLICATION, WE WOULD APPRECIATE ANSWERS TO THE

FOLLOWING PERSONAL QUESTIONS

1. Have either of you ever been informed that you are infertile or do you have reason to believe that such might be the case?

2. Have you ever made an application to any other adoption agency or are you now working through another such agency?

3. What were you told about the results of any previous adoption application?

4. What age and gender do you prefer in an adoptive child?

We have read and answered the foregoing questions to the best of our knowledge. Any additional details are listed below or on the reverse side of this page.

Quick Links

Contact Info

Phone: (727) 391-8096

Fax: 727-399-0026

Email: tara@adoptionadvocatesinc.com

Business Hours

Mon - Fri: 8:00 am - 5:00 pm
Sat - Sun: Closed