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Application Form for Adoption

The document is an application form for prospective adoptive parents, requiring detailed identifying information, economic data, education, employment history, and household members. It includes sections for previous adoption applications, reasons for adopting, child preferences, and willingness to adopt a child with special needs. Additionally, it asks about potential adjustments after adoption and provides space for character references.

Uploaded by

Lyn Jean Mapa Abogado
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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11 views

Application Form for Adoption

The document is an application form for prospective adoptive parents, requiring detailed identifying information, economic data, education, employment history, and household members. It includes sections for previous adoption applications, reasons for adopting, child preferences, and willingness to adopt a child with special needs. Additionally, it asks about potential adjustments after adoption and provides space for character references.

Uploaded by

Lyn Jean Mapa Abogado
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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(LSWDOs LOGO)

APPLICATION FORM
Prospective Adoptive Parent
Please check appropriate box:
Regular
Relative
Independent

IDENTIFYING INFORMATION:

Prospective Adoptive Prospective Adoptive


Father Mother
Name
Age
Date of Birth
Place of Birth
Nationality/Citizenship
Religion
Home Address
Telephone Number/CP Number
E-mail address
Marital Status
If married, date of Marriage
Place of Marriage
Date of Previous Marriage, if any
Manner by which marriage was
terminated; state branch and
number of years
Military services; state branch and
number of years
Membership in
Association/Clubs/Organization

ECONOMIC DATA:
Prospective Adoptive Prospective Adoptive
Father Mother
Occupation
Name of Employer
Business Address
Office Telephone No.
Email Address
Income other than salary
Real Properties
Savings
Insurance
Loan/Debts
EDUCATION

Prospective Adoptive Prospective Adoptive


Father Mother
Elementary
Year Graduated
Honors Received
Name & Location of school
Secondary
Year Graduated
Honors Received
Name & Location of school

College
Year Graduated
Honors Received
Name & Location of school

Graduate School
Year Graduated
Honors Received
Name & Location of school

EMPLOYMENT HISTORY
Prospective Adoptive Prospective Adoptive
Father Mother
Position:

Employer:

Reason & Year of separation from


the company
Position

Employer

Reason & Year of separation from


the company

HOUSEHOLD MEMBERS:
A. List of all individuals living with the couple in present address:

Name Age Sex Relationship Educational Disability


Attainment /Illness, specify
1.
2.
3.
HOUSEHOLD MEMBERS:
A. List of children of either couple/living away from them, if any:
Name Age Sex Relationship Educational Disability
Attainment /Illness, specify
1.
2.
3.,

Have you applied before to adopt a child? If so, where did you file your Application?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

What are your reason/s for adopting?


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

For relative/independent adoption, indicate circumstances, date when you got actual
custody of the child.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Do you have any illness or handicap which may affect the care of the child?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

What are your feelings about the child knowing his/her biological parents?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Child preference: (Please state the gender and age of a child you want to adopt)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Are you willing to adopt a child with special needs? (Ex. Cerebral palsy, epilepsy, with
autism, etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Please state your plan/s to the child you wish to adopt.


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

What changes or adjustment will you make once the child has been placed to your
home? (Ex. Time of work and organization)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

What is your reaction if the social worker interviews your children, relatives, friends and
employer?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Who may be contacted for more information on your character? (Please do not include
relatives)

Name Relation to Applicant/s Address & Contact


Numbers

___________________________ ___________________________
Prospective Adoptive Father Prospective Adoptive Mother
(Signature Over Printed Name) (Signature Over Printed Name)

__________________________ ___________________________
Date Date

__________________________
Social Worker In-charge

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