Preliminary Application

Congrats on taking the first step in your adoption journey! 

AGCI’s Preliminary Application is provided at no cost and with no obligation in order to help determine which adoption programs are the best fit for your family. Our Adoption Advisor will review your Preliminary Application within one business day and will reach out to you to answer any questions and discuss the next steps in your adoption journey.  

Thank you for the opportunity to serve you! 


 

Prospective Adoptive Mother
Mother/Parent 1 Last Name*
*
Mother/Parent 1 First Name*
*
Mother DOB*
*Calendar
Applicants must be at least 23 if married, 25 if single.
Mother Citizenship*
*Show All Countries
Mother Education Level
 
Mother's Occupation*
Mother Height*
*
Enter in inches (in).
Mother Weight*
*
Enter in pounds (lbs).
Prospective Adoptive Father
Please leave all Father fields blank if you are a single applicant.
Father/Parent 2 Last Name*
*
Father/Parent 2 First Name*
*
Father DOB*
*Calendar
Father Citizenship*
*Show All Countries
Father Education Level*
* 
Father's Occupation* *
Father Height*
*
Enter in inches (in).
Father Weight*
*
Enter in pounds (lbs).
Marriage
Marital Status*
 
Marriage Date (if applicable)*
*Calendar
Father Number of Previous Marriages (if applicable)*
*
Mother Number of Previous Marriages (if applicable)*
*
Family Information
Street Address*
Street Address Line 2
City*
State/Region*
Enter Region
Zip Code*
Number of other Children/Persons in Home
Are you currently providing foster care?*
Are you contracted with another agency and/or pursuing another adoption at this time?*
Financial Information
Combined Annual Gross Income* $
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)*
Health & Criminal Information
Has either applicant, or a household member, ever been arrested?*
Applicants with Felonies are not accepted by any of our current programs.
If yes, please provide details of the arrests (misdemeanor, felony, DUI).*
*
Do you own any firearms?
Are you currently pursuing infertility assistance?*
Does either applicant have a current and/or past medical or mental health diagnosis?*
If yes, please explain.*
*
Does either applicant have a history of substance abuse?*
Contact Information
Best Number to Call?*
()-ext
Enter Int'l Number
Home Phone
()-ext
Enter Int'l Number
Home Email*
Would you like a FREE Adoption Consultation?*
When do you expect to begin your adoption?  
Adoptive Child Preferences
  Program of Interest Child Gender Preference  
 
 
   
  Child Pref Min Age Child Pref Max Age  
       
  Are you open to siblings? Are you open to medical conditions?  
       
Statement of Understanding
 

 

I affirm that by submitting this preliminary adoption application that the information provided is true and accurate. I further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime. Additionally, I understand that approval of this pre-application does not guarantee approval of my application, a home study or a placement of a child.
 
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