Application for Services

We are honored that you have chosen to work with Adoption & Beyond! Please complete the following Application for Services. Upon receipt of your application and any applicable fees, we will contact you within a week regarding your application submission.

NOTE: If you have ever completed any forms for us on our website (Information Request Form and/or the Consultation Form), please mark YES, you have submitted information to us before. This will save you time and prevent double entry of information to us. Thanks!

NOTE: International Adoptions- If you are planning on adopting from an international country without the assistance of an international agency please contact us prior to completing this application.

We may be able to save you time by pre-filling the form with the information that you have previously entered.

Have you previously submitted your information to us?

Yes

What services are you applying for?
The application fee is $200 for Home Study and Updated Home Study Services unless you are a returning client. When completing this form please do not use all CAPS or all lower Case. Thanks!
Home Study Services
Updated Home Study Services
Post-Adoption Services- Only
Other
If Other- please make a note below
Note:

Prospective Adoptive Father

Ap 1 LAST Name

Ap 1 FIRST Name

Ap 1 Middle Name

Ap 1 Preferred FIRST Name

If different from Legal First Name

Ap 1 DOB

Race/Nationality

For reporting purposes only

Ap 1 Citizenship

Show All Countries

Ap 1 Occupation

Ap 1 Work Phone

()-ext

Enter International Number

Ap 1 Cell Phone

()-ext

Enter International Number

Ap 1 Primary Email

Ap 1 Preferred Contact Method

Prospective Adoptive Mother

Ap 2 LAST Name

Ap 2 FIRST Name

Ap 2 Middle Name

Ap 2 Preferred FIRST Name

If Different from Legal First Name

Ap 2 DOB

Race/Nationality

For reporting purposes only

Ap 2 Citizenship

Show All Countries

Ap 2 Occupation

Ap 2 Work Phone

()-ext

Enter International Number

Ap 2 Cell Phone

()-ext

Enter International Number

Ap 2 Primary Email

Ap 2 Preferred Contact Method

Marriage Information- If applicable
Marriage Date

Family Address

Street Address

Street Address Line 2

City

State/Region

Enter Region

Zip Code

Family Shipping Address

Only enter Shipping Address if it is different from the Residence Address.

Shipping Street Address

Shipping Street Address Line 2

Shipping City

Shipping State/Region

Enter Region

Shipping Zip Code

Contact

The Primary and/or Secondary e-mail addresses listed in this section will be used when contacting you about your adoption, including but not limited to general announcements, agency news, local and/or national adoption related events and adoption policy changes.

Home Phone

()-ext

Enter International Number

Familys Primary E-Mail Address

Familys Secondary E-Mail Address

Opt Out of Agency E-Mailings

Used only on a limited basis for important information

Opt Out of Agency Mailings

Mailings from us are extremely rare

Password
Please enter a password to use at a later time to access other forms on our website. Please write down and keep this password in a safe place.
Family Login Password	Password Already Set Change Password
Confirm Password
Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.

How did you learn about our agency?
How did you hear about us?	*
Referral Source Details

Family Photo
A close-up Family Photo with all members living in the household. If you do not have an electronic photo available, please mail a photo to our office- labeled with your name and contact information on the back of the photo.
Photo

Previous Home Study
Have you ever had a previous home study process started?	Yes No *
Who started the previous home study process?
Date home study process began
Date home study process was completed or terminated
Did the home study recommend your family and/or other adult members of the household?	Yes No
If No, please explain
If the home study process was terminated, what was the reason for terminating the process?

Criminal History
Federal and state law requires that prospective adoptive parent's complete criminal and child abuse back ground checks. If you have ever been charged, arrested and/or convicted of a crime, please indicate below the approximate dates and nature of record. A criminal record will not necessarily prevent you from adopting a child; however, being dishonest will. It is important that you fully inform us of any such factors in your back ground.
Has Ap 1 ever been arrested or convicted of a crime?	Yes No *
If Yes, please explain	*
Has Ap 2 ever been arrested or convicted of a crime?	Yes No *
If Yes, please explain	*
Has Ap 1 ever been the subject of an investigation by a law enforcement agency for domestic violence or maltreatment of a child?	Yes No *
If Yes, please explain	*
Has Ap 2 ever been the subject of an investigation by a law enforcement agency for domestic violence or maltreatment of a child?	Yes No *
If Yes, please explain	*

Health History
Has Ap 1 had any significant medical or mental health condition?	Yes No *
If Yes, please provide details explaining your diagnosis, prognosis, treatment, life expectancy and its potential effect on your ability to parent a child.	*
Has Ap 2 had any significant medical or mental health condition?	Yes No *
If Yes, please provide details explaining your diagnosis, prognosis, treatment, life expectancy and its potential effect on your ability to parent a child.	*

Financial Stability
Net Worth Positive?	Yes No *
In order to establish a families financial health we will assess the families current Net Worth. Total your assets and minus your liabilities to determine your net worth. Is your net worth positive?

Adoptive Father States/Countries of Residence Since 18 Years Old

Please list all countries and/or states which Applicant 1 has lived in since the age of 18, in which you lived longer than 1 month, or received mail there or had a job there.

How many Countries or States has Ap 1 lived in since 18 years old?

Adoptive Mother States/Countries of Residence Since 18 Years Old

Please list all countries and/or states which Applicant 2 has lived in since the age of 18, in which you lived longer than 1 month, or received mail there or had a job there.

How many Countries or States has Ap 2 lived in since 18 years old?

Persons in Family Home

Enter all persons (living) in home except Applicant 1 and Applicant 2.

Persons in Family Home

	Last Name	First Name	Middle Name	Birth Date	Gender
	*	*		*

Relationship to Family

If Adopted Child, Country Adopted From

Show All Countries

	Additional Information

Please complete this section, if this person is 17 years of age or older

If 18 years of age or older, please list all countries and states which this person has lived in, even if it was only for a few months.

How many Countries or States has this person lived in since 18 years old?