Pre Screening - Confidential Questionnaire

Pre Screening - Confidential Questionnaire

Date ______Last Name______

Address ______

Home Phone ______Fax ______

Marriage Date ______Prior Marriages? ______

Are you willing/able to do text messages for “checking-in” and “updates”?_____

Email address: ______

***Email is required for our clients in their adoption process.It can be set up at a public library if necessary. But, with how much correspondence we have with our clients, it is essential for us to be able to communicate through email with our clients.***

Adopting Parent #1

Name______

(Last)(First)Cell #

Age______Race ______Religion/Denomination ______Annual Income ______Occupation ______Work Phone ______

AdoptingParent #2

Name ______

(Last)(First)Cell#

Age ______Race ______Religion/Denomination ______Annual Income ______Occupation ______Work Phone ______

Children Already

Name Age Living at home Adopted From prior marriage______

Career plans for after adoption? (home/work)______

What have you budgeted for this adoption? ______

How did you hear about Adoption Advisors?______

Racial Ethnic Backgrounds Preferences:

To determine the racial background of the child that you are comfortable with, simply check all items that you would accept and leave blank the ones you would not. Families should feel 100% comfortable with their racial selections. The determination of race is based on information provided by the birth parent(s). Your profile will only be shown to birth parent(s) matching the racial backgrounds you select.

Caucasian ______

Hispanic ______

Asian ______

Native American ______

Caucasian/Hispanic ______

Caucasian/Asian______

Caucasian/Native American______

Full African-American______

AA/Caucasian ______

AA/Hispanic ______

Are you open to twins? ______Are you open to siblings? ______

Are you seeking a newborn only? ______

If you are open to older children, what age? ______

Are you open to special needs? ______(can discuss further)

Do you or anyone living in your home have any criminal history or issues of concern that you think may hinder you from being able to adopt?

What are your experiences with adoption so far?

Who have you already worked with in your adoption process?

What has your experience been with resourcesso far?

Positive:

Negative:

**Please also attach a photo of your family with the questionnaire.**

There is no fee due with this questionnaire. However, if you are approved to work with our agency, you will need to fill out our agency application and submit it with $100. If you have not had your home study done through our agency, we will need to review your home study to be sure it covers South Carolina requirements, and your home study will also need to be submitted with a $250 home study review fee.

Our staff will review each pre-screening questionnaire to determine if your family is a good fit for our services. Upon approval, we will send you our specific adoption packet that would be recommended for your adoption goals.