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Application Form

*This application is confidential and used for internal purposes only. 

*Please allow 1 week for approval.  (You may receive a call from the program director if there are additional questions required.)

*You must allow 1 year after a life changing event before applying (marriage, divorce, death).

*You can apply to adopt 6 months after the birth or adoption of a child but have to wait for the 1 year mark before sending in your dossier.

Please download the INTERNATIONAL ADOPTION SERVICES AGREEMENT 

*Your $300 application fee is non-refundable.  (You will be asked for your credit card upon submitting this application)

*If you have additional documents (doctor’s letters, criminal records, financial statements, etc.) you will be able to upload at the end of this application form.

*If you have already started this application, you can click here to login to resume your application .

*If you have any problems submitting or completing this application Form, please give us a call at 888-899-2349.

Prospective Adoptive Mother
Mother Name Prefix  
First Name* *
Mother Middle Name
Last Name* *
Mother Nick Name
Mother Cell Phone
()-ext
Enter Int'l Number
Mother Email
This email will also serve as your Username for forms you may use with us in the future.
Mother Preferred Contact Method  
Prospective Adoptive Father
Father Name Prefix  
Father First Name* *
Father Middle Name
Father Last Name* *
Father Nick Name
Father Cell Phone
()-ext
Enter Int'l Number
Father Email
Father Preferred Contact Method  
Family Address
Street Address
Street Address Ln 2
City
State/Region*
Enter Region
Zip Code
County
Country
Show All Countries
Contact
Preferred Contact Method  
Home Phone
()-ext
Enter Int'l Number
Home Email*
This email will also serve as your Username for forms you may use with us in the future.
Fax Number
()-ext
Enter Int'l Number
Mother General Information
Mother Social Security Number
- -
Mother Passport Number
Mother Birth Date* *Calendar
Mother Citizenship*
Show All Countries
* At least one parent must be a U.S. Citizen.
Mother Ethnicity/Race (optional)  
Mother Religion  
Mother Education Level  
Mother Other Known Names / Maiden Name
Birth Country
Show All Countries
Father General Information
Father Social Security Number
- -
Father Passport Number
Father Birth Date* *Calendar
Father Citizenship*
Show All Countries
* At least one parent must be a U.S. Citizen.
Father Ethnicity/Race (optional)  
Father Religion  
Father Education Level  
Father Other Known Names
Birth Country
Show All Countries
Family Photo
Please upload a semi-formal photo of the prospective adoptive couple. Do not include other children or pets.

If you do not have an electronic photo available, please mail these photos to our office (labeled with your name and contact information).
Family Photo #1
Marital Information
Marital Status  
If married, Date of Marriage Calendar
Must be married at least 1 year before application can be accepted. Varies from country to country. Check country requirements.
Mother Prior Divorces Number
Father Prior Divorces Number
Are your children immunized?
Mother Parental Rights Ever Terminated
If yes, please explain
Father Parental Rights Ever Terminated
If yes, please explain
Previous Marriages
No more than 2 divorces/annulments per parent.
  Select the combined number of previous marriages between both applicants
Children & Other Persons Living in Family Home
Enter all persons (living) in home except Applicant 1 and Applicant 2.
  Select total people in family home
Adult Children Not in Home
  Adult Children Not in Home
Adoption Information
Does Mother have known or expected infertility?  
If yes, please explain
Does Father have known or expected infertility?  
If yes, please explain
Are you pregnant?
Are you currently working on another adoption besides this application?
Has Mother ever been turned down for adoption by another agency?
If Yes, please explain
Has Father ever been turned down for adoption by another agency?
If Yes, please explain
Adoptive Child Preferences
What is your preference regarding the child you want to adopt?
What country have you chosen to adopt in  
Why have you chosen said country to adopt?
Why do you want to adopt?
Child Gender Preference  
Child Pref Min Age  
Child Pref Max Age  
Siblings
If adopting trans-racially, do you have any concerns you would like to discuss?
Are you applying to adopt a child with special needs?  
Comments:
Pre-Approved for Waiting Child
If you have been pre-approved for a Waiting Child, please provide:
Pre-Approved Waiting Child Name
Pre-Approved Waiting Child Reference #
Home Study / Immigration and Naturalization
(If you live in MO, CHI will do your Home study)  
(If you do not have a home study agency yet, you can still submit the application)
Home Study Agency Worker
Home Study Agency Name
Home Study Agency Address
Home Study Agency City
Home Study Agency State
Enter Region
Home Study Agency Zip
Home Study Agency Contact
Home Study Agency Phone
()-ext
Enter Int'l Number
Home Study Agency Fax
()-ext
Enter Int'l Number
Completed
In Progress
Expected Completion Calendar
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*
Confirm Password *
Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.
 

Upon clicking "Submit", you will be directed to Part 2 of this Application Form.

 
 
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