Adoption Consulting Questionnaire Today's Date MM DD YYYY Full Name of Adopting Parent 1 Full Name of Adopting Parent 2 Email Address of Adopting Parent 1 Email Address of Adopting Parent 2 What city/state do you live in? Address 1 Address 2 City State/Province Zip/Postal Code Country Adopting Parent 1 Age Adopting Parent 2 Age Adopting Relationship Status Male/Female Married Couple Male/Female Unmarried Couple Same-Sex Married Couple Same-Sex Unmarried Couple Single Parent If applicable, what is the date you were married? MM DD YYYY Describe the racial (i.e., Caucasian, African American, Latino, Asian) background of your family What is your heritage? (ex: Irish, German, Nigerian, Brazilian, Nicaraguan, Chinese, Japanese, Indian, Native American) Adopting Parent 1 Citizenship Status Adopting Parent 2 Citizenship Status What is your combined household income? $ What is your adoption budget? $ How many children do you have? What are their ages? Have you adopted before? Yes No Do you have a completed home study? If yes, what date was this home study approved? MM DD YYYY Are you wanting a closed, open or semi-open adoption? Or, if you are not familiar with each type, would you like more information and education regarding each type of adoption? Closed Adoption Open Adoption Semi-open Adoption Not Sure Do you have a preference as to your child’s gender? Yes No Do you have a preference as to your child’s race or ethnicity? Yes No Are you open to substance exposure? If so, which substances are you open to? Yes No How did you hear about Saving Grace? Is there anything additional you would like to share about you and your family? It helps us put a face to your information. Would you be willing to provide us with a photo of you and your family (fur babies too!)? Yes No Thank you!
