Infant Domestic Adoption Home Study Questionnaire
Applicant Information
First Name
Last Name
Date of Birth
Occupation
Home Address
Phone
Email
Household Members
List all household members and ages
Marital/Relationship Status
Status
Single
Married
Partnered
Divorced
Widowed
If applicable, describe your relationship/marriage (length, quality, etc.)
Motivation for Adoption
Why do you want to adopt?
Parenting Experience
Describe any experience with infants or children
Home Environment
Describe your home and neighborhood
Describe the space prepared for the infant
Support System
Who will support you in parenting (family, friends, community)?
Health
Describe your current physical and mental health
Other Information
Anything else you'd like to share?