Sponsorship: New Child Intake
Child Profile
Child ID Number
(
)
-
ext
Enter Int'l Number
Date Form Completed
*
First Name
*
Nombre de Pila
Last Name
*
Apellido
Child Birth Date
*
Fecha de Nacimiento
Gender
*
Female
Male
Genero
Original Location Country
*
United States
Australia
Bulgaria
Burundi
Cambodia
Canada
China
Colombia
Ethiopia
France
Germany
Ghana
Guatemala
Haiti
India
Italy
Kazakhstan
Mexico
Netherlands
Philippines
Russia
South Africa
Sweden
Switzerland
Ukraine
United Kingdom
Show All Countries
Location Region
*
Abi Adi
Addis Ababa
Bogotá
Dogua-Temben
Gambella- East
Gambella- West
Guatemala City
Jemo
Kola Tembien
Lebu
Mekele
Samre
Sponsor Child Location Type
*
Birth Family
Friend
Group Home
Independently Living
If so, what is their current job and how many hours per week do they work?
Si es asi, cual es su trabajo actual y cuantas horas por semana trabaja?
Reason for Seeking Sponsorship
*
Child Status
*
Full Orphan
Half Orphan
Other
Child's Mother
Home Phone
(
)
-
ext
Enter Int'l Number
Is Mother Living?
*
Yes
No
If mother not living, please explain:
Employment Status
Employed
No
Partially employed
Unemployed
Unknown
Yes
Details on Mother's Employment:
Child's Father
Home Phone
(
)
-
ext
Enter Int'l Number
Is Father Living?
*
Yes
No
If father not living, please explain:
Employment Status
Employed
No
Partially employed
Unemployed
Unknown
Yes
Details on Father's Employment:
Family History
NOTE:
Please also complete the SIBLING section at the bottom of this form if the child has siblings.
Does the student have siblings?
*
Yes
No
El residente tiene hermanos?
Are parents divorced?
Yes
No
If yes, how old was the child at time of divorce?
Are parents married?
Yes
No
Legal Guardian
*
Legal Guardian's Relation to Child
*
Birth Mother
Birth Father
Sibling
Grandmother
Grandfather
Aunt
Uncle
Friend
Other
If other, please explain their relationship to the child:
Economic
Please describe the economic condition of the child's family:
*
Medical
Please list any medical conditions the child has been diagnosed with:
Education
Child Grade When Entered Program
*
Kindergarten
Preschool
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
College
Post-Graduate
Currently Enrolled in School?
*
Yes
No
If not, why not in school?
School Name
*
Nombre de la Universidad
Did they graduate to the next grade level after their most recent year?
Yes
No
If not, why did they not move up?
Favorite Subject in School
*
Main Difficulties in School
*
Main Successes in School
*
Developmental / Social
What do they enjoy doing for fun or in their free time?
*
Que le gusta hacer por diversion o en su tiempo libre?
What is their favorite food?
*
Cual es su comida favorita?
What do they want to be when they grow up?
*
Child's Key Personality Trait #1:
*
Child's Key Personality Trait #2:
*
Child's Key Personality Trait #3:
*
Media Release
Media Release Form Received
*
Yes
No
Signature on Media Release
*
Sibling Details
Indique los nombres de los hermanos, la edad, el sexo, el arreglo de vivienda.
Number of Siblings
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Sibling Name
Age
Gender
Lives at Home
Health Status
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
Female
Male
Yes
No
Poor
Average
Good
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