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1 Application
2 Upload Family Photo
3 Submit Fees
4 Fee Payment Timeline

A Hope for Children staff member will contact you within five business days to confirm your application to the adoption program of your choice.

Please complete the following application and return it with the $275 application fee.  If you do not have a recent photograph, you may submit it at a later time.

All information obtained from this application is kept strictly confidential and will be used only for the purpose of assessing your qualifications for adoption and assisting you in your adoption.

Your Electronic Signature will serve as your Original/Wet Signature.

GENERAL INFORMATION

Is this a domestic, or international application?
Domestic

International
Date of Application
   
Select the program you are applying for. 
(International only)
 

Russia
 

China
 

Colombia
 

India
   
Do you have a completed Home Study/Update?
If yes, completed by whom?
Current as of:
 
How did you hear about HOPE for Children? (If by referral, please include a name)
Have you ever been denied an Adoptive Home Study?
If yes, please explain:

PROSPECTIVE FATHER INFORMATION

First Name
Last Name
Email
Date of Birth
Social Security Number
Employer Name
Your Position
Employer Address
City
State
Zip
Work Phone
Church Membership
Marriage Date
Marriage Place
Divorce Date
Divorce Place
Driver’s License No.
Passport Number
Issuing Authority
Issue Date
Explanation

PROSPECTIVE MOTHER INFORMATION

First Name
Last Name
Email
Date of Birth
Social Security Number
Employer Name
Your Position
Employer Address
City
State
Zip
Work Phone
Church Membership
Marriage Date
Marriage Place
Divorce Date
Divorce Place
Driver’s License No.
Passport Number
Issuing Authority
Issue Date
Explanation

STATEMENT OF FAITH:

As adoptive parent(s) with HOPE for Children, we hereby state that we have a relationship with God and are committed to a Christian lifestyle.
Only one parent must initial to accept statement of faith.

CHILD REQUEST:

To best serve you. HOPE for Children would like to know as much as possible about the child you would like to adopt.

Please rank the following 1-3, with 1 (one) being the most important to you in choosing a referral of a child:

Age of the child Health of the child
Sex of the child
Health of the child
Please check the ethnicity of the child which you would be willing to consider:
  
African American
Caucasian
Hispanic
Mixed Ethnicity
International
Number of children you desire to adopt:

CHILD REQUEST Continued:

  Most Preferable Would Consider Least Preferable
Boy
Girl
Siblings
0-12 months old
1-3 years old
4-5 years old
5+ years old
Premature
Cross-Eyed
Club foot/feet
Orthopedic disorders
Cleft palate/cleft lip
Allergies or asthma
Diabetes
Congenital heart defect
Cosmetic factors, i.e. birthmarks
Impaired sight/blindness
Impaired hearing/deafness
Delayed emotional/ mental development
Seizure disorder
Emotional problems
Hepatitis
Attachment Issues
Other (Hemophilia, Cystic Fibrosis, Muscular Dystrophy...)
Specify:

This checklist should not be construed as the agency’s absolute promise that an undesirable condition will never occur, but simply a general idea of how adoptive parents view certain medical conditions, and what conditions may be present in the child. This checklist will NOT be included in the dossier for an international adoption.

HOPE for Children shall be permitted to release an announcement of the child's placement and/or picture of the child in a church or adoptive group publication.

PROSPECTIVE FATHER PROSPECTIVE MOTHER
   
Signature Signature
Date Date

FINANCIAL QUESTIONNAIRE

How do you plan to pay for the various adoption fees? (loan, savings, gift, donations, etc.)

Net Monthly Income:
Wages:
Other:
Total Monthly Income:
Monthly Expenses:
Mortgage/Rent:
Utilities:
Car Payment #1:
Car Payment #2:
Credit Cards:
Church Contribution:
Personal Loans:
Other Living Expenses:
Miscellaneous:
Total Monthly Expenses:
NET MONTHLY INCOME OVER EXPENSES:
 

We hereby authorize HOPE for Children or its representatives, to pursue any investigation (financial or otherwise) it deems necessary in order to properly evaluate us as an adoptive family. We understand and agree that at times it may require independent investigations conducted by personnel hired by HFC.

We hereby acknowledge that we have read and understand the applicable expenses of fee schedule O. Be sure that you fully understand all fees, expenses, and refund policies.

PROSPECTIVE FATHER PROSPECTIVE MOTHER
   
Signature Signature
Date Date

GENERAL HEATH AND OTHER INFORMATION:

If you have any questions about your eligibility please contact HOPE for Children, or your Program director.

Has either applicant ever been accused or convicted of child abuse?
Has either applicant ever received psychiatric or psychological counseling?
Does either applicant have a history of prolonged usage of alcohol, drugs or narcotics
(personal or family)?
Has either applicant ever suffered any sexual or physical abuse in childhood?
If yes to any of the above, please explain:
Has either applicant ever been involved in any sexual abuse as an adult?
If yes to any of the above, please explain:
Has either applicant ever been arrested for any reason? (These include but are not limited to DUI, Domestic Violence, trespassing, etc., even if found not guilty.)
If yes to any of the above, please explain:
Has either applicant ever been convicted of any criminal offense? (These include but are not limited to DUI, Domestic Violence, trespassing, etc.)
If yes to any of the above, please explain:
Please list the names, date of birth and relationship of any other persons living with you including children:
Name
Date of Birth
Relationship
   
Name
Date of Birth
Relationship
   
Name
Date of Birth
Relationship
   
Name
Date of Birth
Relationship
   

FATHER'S MEDICAL BACKGROUND

Alcoholism
  
Liver disease/ hepatitis /jaundice
Anemia
  
Lung disease, tuberculosis
Arthritis
 
Mental illness
Asthma
  
Mental impairment
Blood transfusion(s)
  
Mood disorder
Cancer or tumor
 
Neurological disorder
Depression
  
Obesity
Diabetes
  
Personality disorder
Drug abuse
  
Physical impairment
Epilepsy, seizures
  
Sexually transmitted disease
Head injuries
  
Smoking
Heart disease
  
Strokes/ cholesterol
High blood pressure
  
Suicide attempts
HIV/AIDS
  
Thyroid disease
Homosexuality
 
Ulcer in stomach/ duodenum
Kidney problems
  
 
     
 

 

Are there any medical conditions not listed above that you have been diagnosed with?
Please indicate which medications you are currently taking, with or without a prescription, and the reason(s) you are taking these medications.
   

I state that I have been truthful and have provided information on all medical conditions and lifestyle issues that apply to me to the bes