AGCI Application Form

AS YOU BEGIN...

Congratulations on your decision to begin your journey of adoption! All God's Children International has united families through adoption for over twenty years. Our caring staff is committed to guiding you through your home study process and working with you to answer all of your questions and concerns along the way.

Please include the following when submitting your application:

1. One family photo with all members living in the home
2. One photo of the exterior of the house
3. $300 Non-refundable processing fee

Please note the time sensitivity of this document.
This application will expire after 90 days and a new application and fee will be required.

AGCI will contact you within two business days of receipt of these items to review your application with you. Upon approval, you will then receive an Orientation Packet that will guide you through the next steps of your home study process.

Thank you for considering AGCI. We look forward to working with you!

If you have any questions as you complete this application, please contact Inquiry Services at (800) 214-6719.  

Application Type Application Type Adoption Home Study Only  Prospective Adoptive Father Father Last Name* * Father First Name* * Father Middle Name Father Preferred Name Father Height* * Enter in inches (in). Father Weight* * Enter in pounds (lbs). Father DOB* * Father Citizenship* United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom * Show All Countries Father Country of Birth Father Social Security Number - - Father's Religion (optional) Father Education Level* Elementary High School Junior High Some College Associates Technical Bachelors Masters Doctorate Can read and write GED *  Family Address Street Address* Street Address Line 2 City* State/Region* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code* County Country United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries Contact Home Phone* ()-ext Enter Int'l Number Home Email* Father Email Father Cell Phone* ()-ext Enter Int'l Number Father Work Phone ()-ext Enter Int'l Number Mother Email Cell Phone* ()-ext Enter Int'l Number Work Phone ()-ext Enter Int'l Number Preferred Contact Method Home Phone Home Email Father Email Mother Email Father Work Email Mother Work Email Father Cell Phone Mother Cell Phone Father Work Phone Mother Work Phone Attorney   Financial Information Father's Occupation* * Employer's Name Father Job Title Father's Annual Gross Income* $* Does Father plan on changing jobs in the next two years? YesNo Does Father anticipate any changes to their financial situation in the next two years? YesNo Has Father ever filed for Bankruptcy?* YesNo* Mother's Occupation* * Employer's Name Mother Job Title Mother's Annual Gross Income* $* Does Mother plan on changing jobs in the next two years? YesNo Does Mother anticipate any changes to their financial situation in the next two years? YesNo Has Mother ever filed for Bankruptcy?* YesNo* Additional Sources of Income Combined Annual Gross Income* $ Net Monthly Expense $ Net Monthly Income $ Is your family currently receiving any form of state or federal assistance (i.e. cash, food, medical insurance, etc.)? If yes, please explain. Total Assets (everything you own of cash value) (i.e. - market value of home, savings, investments, 401 K, blue book value of car(s))* Total Liabilities (everything you owe) (i.e. - mortgage, car loans, student loans, credit card debt)* Net Worth (total assets minus total liabilities)* Plan to Fund Your Adoption

Prospective Adoptive Mother Mother Last Name* * Mother* * Mother Middle Name Mother Preferred Name Mother Height* * Enter in inches (in). Mother Weight* * Enter in pounds (lbs). Mother DOB* * Mother Citizenship* United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom * Show All Countries Mother Country of Birth Mother Social Security Number - - Mother's Religion (optional) Mother Education Level* Elementary High School Junior High Some College Associates Technical Bachelors Masters Doctorate Can read and write GED *  Family Shipping Address (if different) Shipping Street Address Shipping Street Address Line 2 Shipping City Shipping State/Region AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Shipping Zip Code Shipping Country United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries Marriage Marital Status* Divorced Married Single Widowed   Marriage Date (if applicable)* * Father Number of Previous Marriages (if applicable)* * Mother Number of Previous Marriages (if applicable)* * Previous Marriages Please complete this section if either of the applicants have had any previous marriages. Father Previous Marriage #1 Date Father Previous Divorce #1 Date Father Why Marriage #1 Ended Father Child/Custody Arrangements #1 Father Previous Marriage #2 Date Father Previous Divorce #2 Date Father Why Marriage #2 Ended Father Child/Custody Arrangements #2 Mother Previous Marriage #1 Date Mother Previous Divorce #1 Date Mother Why Marriage #1 Ended Mother Child/Custody Arrangements #1 Mother Previous Marriage #2 Date Mother Previous Divorce #2 Date Mother Why Marriage #2 Ended Mother Child/Custody Arrangements #2 Password Please enter a password to use at a later time to access other forms on our website. Please write down and keep this password in a safe place, as your password cannot be accessed by AGCI. Family Login Password* Password Already Set Change Password Confirm Password * Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.

Other Persons/Children in Family Home

Please list all children (related and un-related) that the prospective adoptive father and prospective adoptive mother have, as well as any adults (related or un-related) living in the family home. This includes any children who are currently attending college but come home on weekends and/or for extended vacations, as well as children who are in the custody of their parent 50 percent or more of the year. If any of your children were adopted, please include a letter from your previous agency, on their letterhead, confirming post adoption compliance.

Persons in Family Home 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

	Last Name	First Name

	Birth Date	Gender
		Male Female

	If adopted, from which country?	Placement Date	Did you complete all required post adoption reports?	Did you re-adopt your child?
	United States Australia Cambodia Canada China Ethiopia France Germany Ghana Guatemala India Italy Kazakhstan Mexico Netherlands Russia Sweden Switzerland Ukraine United Kingdom Show All Countries		YesNo	YesNo

	Reason for Being in the Home	Custody Arrangements (if applicable)?	Relationship to Family
			Adopted Child Aunt Bio-Daughter Bio-Son Brother Cousin Ex-Husband Ex-Wife Foster Child Friend Grandfather Grandmother Nephew Niece Other Parent Sister Stepchild Stepfather Stepmother Uncle

Children Not in Home

Please list all children that the prospective adoptive father and prospective adoptive mother have, that do not currently live in the home. This includes children attending college that do not come home on weekends and/or extended vacations, children whom you do not have 50 percent yearly custody of and any children that you have either lost parental rights of or have no relationship with. If any of your children were adopted previously, please include a letter from your previous agency, on thier letterhead, confirming post adoption compliance.

Number of children who are not currently living in your home 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

	Last Name	First Name

	Date of Birth	Gender

	If adopted, from what country?	If adopted, placement date?	If adopted, were you compliant on post adoption reports?	If adopted, were they re-adopted?

	Reason Not in Home	Custody Arrangements (if applicable)

	Phone Number	Email Address

Please indicate how important the following were in your decision to apply with us.

Decision to Apply Comments

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