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Preliminary Application
 
Type of Adoption Interested In
 
Name
Date of Birth
Address
City
State
Postal Code
Home Phone
Cell Phone
Work Phone
Fax
 
Email
 
Spouse/Partner
Date of Birth
Work Phone
Cell Phone
 
Email
 
Are there Children in the Home
If yes, what are their ages?
Number of Adopted Children
Others Living in Home?
Date of Marriage
Date of Previous Marriages or Divorces
I am Interested in Adopting the Following Type of Child
(*Optional for Waiting Child Adoption Program and International Adoption Only)
Country
Siblings Number
Racial Background
Age Range
  APPLICANT   SPOUSE/PARTNER
       
Employer
Employer
Address
Address
City
City
State
State
Postal Code
Postal Code
Job Title
Job Title
Salary
Salary
       
Will one parent be able to take a leave when the child arrives?
Do you have health insurance that will cover the child upon placement?
Has a child ever been removed from your home?
Have you or anyone living in your home ever been arrested, charged or convicted of a criminal offense?
If you entered "yes" to either of the two previous questions, please submit a letter of explanation.
Do you feel particularly able to parent a child with emotional problems, developmental delays or a physical disability?

If you answered "Yes" what type of problems do you feel you can handle and why?

Briefly, Why do you wish to adopt?
FAMILY ASSESSMENT (HOME STUDY) STATUS

We are required to contact previous agencies with whom you have worked. Have you ever applied to another agency for adoption or foster care?

If so, was a previous family assessment completed?
If you worked with a previous agency, please provide the following information
Agency Name
Address
City
State
Postal Code
Phone
Caseworker

I, We understand that the preliminary application fee of $100 covers a consultation with the staff of Adoption Alliance and is nonrefundable. This application and fee does not guarantee receipt of Formal Application or placement of a child. By checking this box you are agreeing with the above statement.

Adoption Alliance can accommodate special needs of families we serve. Please indicate if you need:
  • ASL Translation Service
  • Translation Service in the Following Language
  • Accommodation for Physical Disability (i.e. wheelchair access, sight impairment)
  • Transportation
  • Other
How/Where did you Hear about Adoption Alliance

Comments and Remarks

You may submit this form electronically by hitting the submit button below. You will be prompted to submit your application fee on the following page. If you prefer to submit your application by mail, please press the print link and mail your application along with payment to:

Adoption Alliance, 2121 S. Oneida Street Suite 420, Denver, CO 80224

You will be contacted by Adoption Alliance within 3 business days of receipt of application and payment.

Print a copy of this application for your records before you press Submit

Office Use Only

Date Received________________ Fee Paid _____________ AIRS Case #____________