Preliminary Application


Congratulations on your decision to explore adoption. This Preliminary Application is a free, no obligation service provided by All God's Children International to help determine which programs are the best fit for your family.  It requests some general information about your family so our staff can determine the best programs available to you, as each program has different requirements. If you would like to skip this step and formally apply today, please click here

Upon submission of a Preliminary Application you will receive a password to view our Waiting Child Photolistings.  The countries we work with require this type of process to help protect the privacy and security of their waiting children.

Our Inquiry Staff will review your Preliminary Application and contact you to provide our recommendations, answer your questions, and discuss the next steps toward building your family through adoption.  We look forward to serving you.

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*
*Calendar
Mother Citizenship*
*Show All Countries
Mother Education Level
 
Mother's Occupation
Family Information
Street Address*
Street Address Line 2
City*
State/Region*
Enter Region
Zip Code*
Country
Show All Countries
Are you currently providing foster care?*
Are you contracted with another agency and/or pursuing another adoption at this time?*
Have you ever been declined for an adoption?*
Has either applicant had their Parental Rights terminated?*
If yes, please provide history of parental rights termination.*
*
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)*
Have either applicant filed for Bankruptcy in the past 5 years?*
Will your health insurance cover a child with pre-existing conditions upon the child's placement with your family?*
Contact Information
Home Phone*
()-ext
Enter Int'l Number
Cell Phone
()-ext
Enter Int'l Number
Home Email*
Would you prefer to receive a hard copy of the information packet, instead of an electronic version?*
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*
Confirm Password *
Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.
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*
*Calendar
Father Citizenship*
*Show All Countries
Father Education Level*
* 
Father's Occupation* *
Marriage
Marital Status*
 
Marriage Date (if applicable)*
*Calendar
Father Number of Previous Marriages (if applicable)*
*
Mother Number of Previous Marriages (if applicable)*
*
Number of Bedrooms in Home*
Health & Criminal Information
Has either applicant, or a household member, ever been arrested?*
If yes, please provide details of the arrests (misdemeanor, felony, DUI).*
*
Does either applicant have a history of, or is currently pursuing infertility assistance?*
If yes, please provide history of infertility assistance.*
*
Has either applicant experienced the loss of a child, including miscarriage?*
If yes, please provide history of loss.*
*
Does either applicant have a current and/or past medical or mental health diagnosis?*
If yes, please provide dates, diagnosis and treatment history.*
*
Does either applicant have a history of substance abuse?*
If yes, please provide dates and treatment history.*
*
Has either applicant received Counseling?*
If yes, please provide dates and counseling history.*
*
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
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.

  Children Not in Home
Please indicate how important the following were in your decision to apply with us.
Decision to Apply
Comments
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 Special Needs?  
       
Additional Comments and Information
  Additional Comments  
   
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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