Adoption Preference
Personal Visits (Open)
—Please choose an option— Yes No by Case
Send Pictures and Letters (Semi-Open)
—Please choose an option— Yes No by Case
No Contact (Closed)
—Please choose an option— Yes No by Case
Are you open to a Birthmother that uses Nicotine?
—Please choose an option— Yes No by Case
Are you open to a Birthmother that consumes Alcohol?
—Please choose an option— Yes No by Case
Are you open to a Birthmother that uses Marijuana?
—Please choose an option— Yes No by Case
Are you open to a Birthmother that uses Illicit Drugs?
—Please choose an option— Yes No by Case
Are you open to a Birthmother that has been treated for Mental
Disorders?
—Please choose an option— Yes No by Case
What Gender are you seeking?
—Please choose an option— Boy Girl No Preference
What is the highest percentage of any given race would you consider
adopting?
Caucasian
—Please choose an option— 100% 50% 0%
African American
—Please choose an option— 100% 50% 0%
Hispanic
—Please choose an option— 100% 50% 0%
Asian
—Please choose an option— 100% 50% 0%
What is your adoption budget for Legal Expenses? (FORMAT numeric
only)
What is your adoption budget for Birthmother Living Expenses? (FORMAT
numeric only)
Do you have a completed Home Study?
—Please choose an option— Yes No
Date Home Study completed (FORMAT mm/dd/yyyy)
Month Day Year
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