World Child Application
Please print out this form, or download a PDF version of this form.
Requires Adobe Acrobat
Reader
|
Name of Applicant(s) |
Mr. ___________________________________________________________ |
|
(Full, legal names) |
Ms. ___________________________________________________________ |
|
Address: |
_______________________________________________________________ |
|
|
Home |
Work (Mr.) |
Work (Ms.) |
|
Telephone Numbers |
|
|
|
|
Fax Numbers |
|
|
|
|
Email Address |
|
|
|
PERSONAL INFORMATION
|
|
Male Applicant |
Female Applicant |
|
Age/Date of Birth |
|
|
|
Religious Preference |
|
|
|
Education |
|
|
|
Occupation |
|
|
|
Approximate Income |
|
|
|
Approximate Savings |
|
|
Physical Description
(height, weight) |
|
|
Limiting physical treatment
(describe circumstances
and give dates) |
|
|
Mental Health Treatment
(give applicable dates
and circumstances) |
|
|
Record of arrest(s) / conviction(s)
(if yes, please explain) |
|
|
|
Date of Marriage |
|
|
|
Number of previous marriages |
|
|
Biological children, if any
(number, age, sex, origin) |
|
|
Adopted children, if any
(number, age, sex, origin) |
|
|
|
Passport number/expiration date |
|
|
|
Social Security Number |
|
|
Country or Ethnicity
of Child Desired |
|
|
|
Citizenship |
|
|
Request for: _____Homestudy _____Foreign
Placement _____Both
|
World Child International - Initial Application for Child
Placement: Foreign Child Adoption Questionnaire |
|
Please describe the child or children you wish to adopt. Include
age range, race, health or handicap, number of siblings, and
whether or not you accept either sex:
Please identify how you first heard of World Child International.
(i.e. personal referral, newspaper ad, etc.)
|
|
Study Process; Documentation; Travel
1) Do you have an approved home study by a licensed child-placement
agency?
Yes ____ No ____ Anticipated
Date: _____
If yes, give name of agency, social worker, address, telephone
number, approval date:
If no, please have your social worker contact World Child International
for a home study outline. Explain your specific plan,
if known, and time frame for receiving a home study, giving name
of anticipated agency.
|
2) INS Status - Have you opened an I-600A file with your
local U.S. Immigration and Naturalization Service office?
Yes ____ No ____
If yes, in what city? __________________________ Date
filed _____________ |
3) Do you at present have an active application with any other
adoption agency where there is a possibility of the placement
of a child with you?
Yes____ No____ |
|
4) Most countries require the parents to travel to adopt their
child. This trip may last from three days to six weeks, depending
upon the laws of the country. Please indicate any travel constraints:
|
|
In order to process this application, we ask that you include
a non-refundable check payable to World Child International
for the amount of $225.00 along with a photo(s) of each family
member living in the household. The receipt of this application
does not place you on a waiting list: receipt of the homestudy
is when services begin. Also, applicants need to be willing
to adopt a child from more than one country. |
|
|
I/We, the undersigned, hereby confirm under the penalties
of perjury that all of the information contained herein is current,
complete and accurate, upon our personal knowledge.
Applicants signature______________________________ Date___________________
Applicants signature______________________________ Date___________________ |
Return to:
World Child International, 9300 Columbia Blvd., Silver Spring,
Maryland 20910
World Child Home |