Adoption Inquiry Form - Virginia Department of Social Services

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Adoption Inquiry Form

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The purpose of this form is to refer families to appropriate agencies for adoption services and to assist agencies in the recruitment of families for Virginia's waiting children. This is not an application.
If you are interested in adopting a child, you must have a completed home study as part of the adoption process. A home study will explore the proposed adoptive environment.

Applicant Information (test)

Name:	*
Race:
Marital Status:
Spouse's name (if applicable):
Spouse' Race:
E-mail:	*
Address:
City:
State:
Zip:	*
Home Phone:
Work Phone:
Information Requested:

Characteristics of Child You Want to Adopt

Sex Female Male Either

Age:

Disabled ? Yes No Will Consider

Siblings: Yes No Will Consider

Race:

Please list the names and Case Numbers (if known) of the Children you are interested in adopting:

Comments:

Home Study

Do you already have an approved Adoptive Homestudy? Yes No

If you already have an approved Adoptive Homestudy

Date Completed:
Agency Name:
Case Worker Name:
Case Worker E-mail:
Agency Address:
Agency City:
State:
Zip:
Agency Phone:

Are you a Robot?

(form # 032-02-0153-00-eng)

* Required fields

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(deaf or hard-of-hearing):

(800) 828-1120, or 711

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