This is an adoption application for parents planning on adopting a child. This is a
standard form that is sent to adoption agencies and contains information regarding the
parents' background, education, finances, as well as other information the agencies
deem necessary to the adoption process. This application is useful for parents who are
considering adopting a child.
Child desired: Sex _________, Age _________.
Applicants for Child
Names:
Husband ______________________ (Last name first) Date of Birth:
Wife ________________________(Maiden name first) Date of Birth
Address _________, City _________, County _________, State ____Zip Code ______ Phone Number _________
Last Previous Address _________ Date of Moving
Nationality of Husband _________; of Wife _________.
Marriage Information
Name of Church _________, City _________, State _________.
Date of Marriage _________. Please submit marriage certificate with this application. If either party has been
previously married, give details _________.
Religious and Educational Status
Husband:
Baptism:
Confirmation:
First Communion:
Schools attended:
Wife:
Baptism:
Confirmation:
First Communion:
Schools attended:
2 of 5
Church and School
Name of church you attend
Address
Name of Pastor
Distance from home of nearest parochial school
Children or Other Members of Family Living at Home
Name Relationship Birth date Religion
Name Relationship Birth date Religion
Is any member of your family a mental or physical invalid?
Description of Applicants
Husband: Height Weight Color of Eyes Color of Hair Complexion
Wife: Height Weight Color of Eyes Color of Hair Complexion
Child: Height Weight Color of Eyes Color of Hair Complexion
Child: Height Weight Color of Eyes Color of Hair Complexion
Please send us photographs.
Under Family list mother, father, brothers, sisters. If any are deceased, give date and cause of death.
Husband's Family:
Name Address Age Religion Practicing? Number of
Children
Name Address Age Religion Practicing? Number of
Children
Name Address Age Religion Practicing? Number of
Children
Wife's Family:
Name Address Age Religion Practicing? Number of
Children
3 of 5
Name Address Age Religion Practicing? Number of
Children
Name Address Age Religion Practicing? Number of
Children
Note any instances of legal adoption of brothers, sisters, or nephews and nieces.
Home of Applicant
Private Dwelling?
Apartment?
Number of Rooms
If owned, what is the value?
Purchase price?
Present mortgage?
Amount of monthly rent or mortgage payments?
What business, if any, is conducted in the building in which the applicants reside?
Finances of Family
Husband:
Occupation _________, Name of Firm _________, Address _________, Phone _________, How Long _________,
Income _________.
Previous Employment: _________, Dates _________._________, Dates _________.
Military record? Dates _________, Rank or Rating _________, Type of Discharge: _________.
Wife:
Occupation _________, Name of Firm _________, Address _________, Phone _________, Dates _________,
Income _________.
Previous Employment: _________, Dates _________._________, Dates _________.