Adoption Information Form

Please provide the information requested below. The information requested is necessary to prepare your court documents. Adoptions are very detail oriented. Complete and accurate information is essential. Incomplete, Inaccurate, or inconsistent information will cause delays and additional expenses.

Adoption Information Form

Type of Adoption

Jurisdiction – Choose one of the choices from the pull-down menu

Child / Adoptee

Full Name as Entered on Birth Certificate

If Different, Current Full Name as it Appears on Identification Documents

Full Name as Entered You Wish For It to be Entered on the New Birth Certificate When the Adoption is Completed

Citizenship

If you have participated in any litigation concerning the child, or if you have information about a custody proceeding involving the child, provide the following:

If you know of a person who has physical custody or claims to have custody or visitation rights with respect to the child, provide the following:

Provide the following information about where the child has lived during the past five years:

PARENT 1

Biological / Gestational Mother

Full name as entered on birth certificate

If different, current full name as it appears on identification documents

Education

If you are divorced or widowed, provide the following information about your former spouse #1:

Name of child’s Birth Parent 2 (Father)

Name of child’s Birth Parent 2 (if more than one possible father)

Name of child’s legal father of child

Parent 2

Legal Father of the Child

Full name as entered on birth certificate

If different, current full name as it appears on identification documents

Education

Military Status

Name of Spouse

If you are divorced or widowed, provide the following information about your former spouse #1:

Biological Father #1 - If different from the legal father of the child.

Full name as entered on birth certificate

If different, current full name as it appears on identification documents

Education

Military Status

Name of Spouse

If you are divorced or widowed, provide the following information about your former spouse #1:

Biological Father #2 – If more than one possible biological father of the child.

Full name as entered on birth certificate

If different, current full name as it appears on identification documents

Education

Military Status

Name of Spouse

If you are divorced or widowed, provide the following information about your former spouse #1:

Adoptive Parent 1

Full name as entered on birth certificate

If different, current full name as it appears on identification documents

Education

Military Status

Name of Spouse

If you are divorced or widowed, provide the following information about your former spouse #1:

If you are divorced or widowed, provide the following information about your former spouse #2

Adoptive Parent 2

Agency

Who prepared your home study?

Agency contact person

Home Study

Placement – If a child was placed with you by an agency

Agency contact person

Postplacement reports

Agency contact person

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