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111 First Street, Suite 902, Miami, Florida 33132

Telephone :(305) 358-2442/2445

Facsimile :(305) 433-7817

Web :WWW.ADOPTAMERICA411.COM

Email: info@adoptamerica411.com

APPLICATION

Please complete the following information as completely and accurately as possible. If you need assistance, please call 305.358.2442/2445 All information that you disclose in this application is strictly confidential. If mailing it, please print clearly. Our application fee is $250. You can download, print and fax this application to 305.358.2442/2445

Applying for Home Study services (must be Florida resident)Applying for Adoption Services

SECTION I: APPLICANT(S) INFORMATION

SECTION II: APPLICANT BACKGROUND INFORMATION

MaleFemale

years

NoYes

NoYes

NoYes

NoYes

NoYes?

NoYes

SECTION III: SPOUSE BACKGROUND INFORMATION [IF APPLICABLE]

MaleFemale

years

NoYes

NoYes

NoYes

NoYes

NoYes?

NoYes

SECTION IV:

YesNo

NoYes

SECTION V: PREFERENCES

Race of Child

yesno

SECTION VI: PROCESS INFORMATION

NoYes (please specify below)

NoYes (please specify below)

If you are mailing or faxing this form, please certify by completing the entries below. If you are submitting this form online, please enter name(s) in the "Printed Name"sections only

I/We represent that all information in this application is true, accurate, and complete, and is given to AdoptInternational for entry to its adoption program.


111 First Street, Suite 902, Miami, Florida 33132

Telephone :(305) 358-2442/2445

Facsimile :(305) 433-7817

Web :WWW.ADOPTAMERICA411.COM

Email: info@adoptamerica411.com