Adoption Preferences Form

Please fill in your adoption preferences as soon as possible to assist your adoption consultant with placement options.

Preferred gender:
Please SelectMaleFemaleNo Preference

Preferred age:
Please SelectNewborn Only Newborn up to 6 Month Old Newborn up to 1 Year OldNewborn up to 2 Year OldNewborn up to 3 Year OldAny Child Under 5 Any Child Under 8Any Child Under 10Open to child of any age

Preferred # of Children:
Please SelectSingleSingle or TwinsSingle Child or Sibling Group of Older Children

Preferred Level of Openness (Ongoing Relationship with Birth Family):
Please SelectOpen AdoptionSemi-Open AdoptionClosed AdoptionWould consider depending on the situation

Are you open to a child with special needs?
Please SelectYesNoWould consider depending on the situation

Are you open to a child with prenatal substance exposure?
Please SelectYesNoWould consider depending on the situation

Are you open to a child with alcohol exposure?
Please SelectYesNoWould consider depending on the situation

Are you open to a child with a family history of mental illness?
Please SelectYesNoWould consider depending on the situation

Preferred Ethnicity:
Please Select
Caucasian
Black or African American
Hispanic
Multi-Racial including African American
Multi-Racial not including African American
American Indian
Asian
Pacific Islander
Open to ALL ethnicities and races

Maximum Budget Amount for Adoption Expenses:
Please Select$45K-$50K$40K-$45K$38K-$40K$38K or less *Note this amount falls outside of average adoption fees and may need to be increased through adoption fundraising, grants and/or funding.$50K+

Current Funds Available for Adoption Expenses
(Outside of home study, profile book, consulting, or travel costs):