Special Needs Adoption Request Form
Applicant Information
Full Name
Date of Birth
Address
Phone Number
Email Address
Occupation
Family Information
Spouse/Partner Name
Number of Children in Household
Other Household Members / Details
Adoption Preferences
Preferred Age Range of Child
Types of Special Needs Considered
Experience Caring for Children with Special Needs
Motivation and Support
Please describe your motivation for adopting a child with special needs
Support System Available (family, community, etc.)
Any Additional Information