Preliminary Application

You may submit this form electronically by hitting the submit button below. You will be prompted to submit your $150 application fee on the following page. If you prefer to submit your application by mail, please print and mail your application along with payment to:

Adoption Alliance, 2121 S. Oneida Street Suite 420, Denver, CO 80224

You will be contacted by Adoption Alliance within 3 business days of receipt of application and payment. We are temporarily not accepting preliminary applications for our Mexico adoption program.

Print a copy of this application for your records before you press Submit.

	Type of Adoption Interested In:
* First & Last Name
* Date of Birth
* Email
* Street Address
* City
* State
* Postal Code
Home Phone
Work Phone
Cell Phone
Fax
________________________________________
Spouse/Partner
First & Last Name
Date of Birth
Work Phone
Cell Phone
Email
________________________________________
	Are there children in the home?
	If yes, what are their ages?
	Number of Adopted Children:
	Others living in the home?
	Date of Marriage
	Date of previous marriages or divorces
	I am interested in adopting the following type of child:
Age Range:
Racial Background:
Country:
	Number of Children interested in:
Siblings:
_______________________________________
Applicant's Employer
Employer's Street Address
City, State, Postal Code
Job Title
Salary
________________________________________
Spouse/Partner's Employer
Employer's Street Address
City, State, Postal Code
Job Title
Salary
________________________________________
	Will one parent be able to take leave when the child arrives?
	Do you have health insurance that will cover the child upon placement?
	Has a child ever been removed from your home?
	Have you or anyone living in your home ever been arrested, charged or convicted of a criminal offense?
	If you answered yes to either of the two previous questions, please attach a letter of explanation: (1 MB max)
	Do you feel particularly able to parent a child with emotional problems, developmental delays or a physical disability?
	If you answered yes, what type of problems do you feel you can handle and why?
	Briefly, why do you wish to adopt?
________________________________________
FAMILY ASSESSMENT (HOME STUDY) STATUS
	We are required to contact previous agencies with whom you have worked. Have you ever applied to another agency for adoption or foster care?
	If so, was a previous famiy assessment completed?
If you worked with a previous agency, please provide the following information:
Agency Name:
Street Address:
City, State, Postal Code:
Phone:
Caseworker:
________________________________________
	* I, We understand that the preliminary application fee of $150 covers a consultation with the staff of Adoption Alliance and is nonrefundable. This application and fee does not guarantee receipt of Formal Application or placement of a child. By checking this box you are agreeing with the above statement.
________________________________________
Adoption Alliance can accomodate special needs of families we serve. Please indicate if you need:
	Translation service in the following language:
	Accomodation for physical disability:
	Transportation:
	Other:
________________________________________
	How/Where did you hear about Adoption Alliance?
	Comments/Remarks:
________________________________________
* Required Fields

See our Program Guide (below) for information on our programs, services, and fees.

	Adoption Alliance Program Guide (293 KB)

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