CHA Adoption Application

Co-Applicant Name (if applicable)

First Name Last Name
Is the Co-Applicant's address the same as above?

Yes No
Co-Applicant Address (if different than above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Co-Applicant's Email
example@example.com
Is the Co-Applicant over 21 years old?

Yes No
Is the Co-Applicant employed?

Yes No
Co-Applicant's Employer
Co-Applicant's Occupation
How Long?
Is the Co-Applicant a student?

Yes No
If YES, Graduation Date and Name of School?