Kinship Adoption Application Supplement

Kinship Adoption Application Supplement

Please complete this required document with thoughtful and detailed information and return it with your application and applicable fee. If you do not readily have the information or documents requested, you can always return to this form and make edits or upload documents as they may become available to you. Not all families have access to this records and that is also acceptable when completing this important document.
Prospective Adoptive Parent #1*

First NameLast Name
Prospective Adoptive Parent #2 (if applicable)

First NameLast Name
Email*
example@example.com
What country does the child(ren) live in?*
Please explain in detail the circumstances, date, relevant names, and location which resulted in your relative's child to qualify as an orphan under US Immigration law.
Which scenario below best describes how the child qualifies as an orphan under US Immigration laws:*

The child(ren) does not have any parents because of the death or disappearance of, abandonment or desertion by, or separation or loss from, both parents.The child has a sole or surviving parent who is unable to care for the child, consistent with the local standards of the foreign sending country, and who has, in writing, irrevocably released the child for emigration and adoption.
If there is a sole surviving parent, due to spouse's death or abandonment, is the remaining sole surviving parent presently married again?

YESNO
IMPORTANT CRITERIA TO BE AWARE OF:

You must file an orphan petition before the child’s 16th birthday, or before the child’s 18th birthday, if the child is a birth sibling of another child whom you have also adopted and who immigrated (or will immigrate) as:

1. Is an orphan based on a Form I-600 petition filed before the sibling’s 16th birthday

-OR-

2. Is an “adopted child” as defined in Section 101(b)(1)(E) of the Immigration and Nationality Act (INA) provided the actual adoption took place before that sibling’s 16th birthday
The purpose of this document is attached to 22 CFR 96.48 (c) (1-3)

The agency provides the prospective adoptive parent(s) with training that allows them to be as fully prepared as possible for the adoption of a particular child. This includes counseling on the following:
Has the child(ren) been adopted in the foreign country prior to today's contact?

YESNO
What is the child's legal relation to you?
example: maternal/paternal niece, nephew, brother, sister, cousin, etc.
Name of Child #1*

First NameLast Name
Birth Date of Child #1 *

MonthDayYear
Date
Name of Child #2

First NameLast Name
Birth Date of Child #2

MonthDayYear
Date
Name of Child #3

First NameLast Name
Birth Date of Child #3

MonthDayYear
Date
Name of Child #4

First NameLast Name
Birth Date of Child #4

MonthDayYear
Date
Name of Child #5

First NameLast Name
Birth Date of Child #5

MonthDayYear
Date
Does this child have siblings?

YESNO
If yes, provide an explanation if there is no intention to adopt the entire sibling group.
22 CFR 96.48(c)(1) Describe the child(ren)'s country of origin's history.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(1) Describe the child(ren)'s country of origin's cultural.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(1) Describe the child(ren)'s racial background.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(1) Describe the child(ren)'s religious background.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(1) Describe the child(ren)'s ethnic background.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(1) Describe the child(ren)'s linguistic background.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(2) Describe the known health risks in the specific region or country where the child(ren) resides.
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any medical history known about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any social history known about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any known background about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any known birth history about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any known educational data about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any known developmental history about the particular child(ren).
Be as thoughtful and detailed as possible.
22 CFR 96.48(c)(3) Describe any other data about the particular child(ren).
Be as thoughtful and detailed as possible.
If you have copies of the child(ren)'s biological parent's birth certificates, please upload here.

Skip this request if you do not have this record or is it is not available to you.
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If you have copies of the child(ren)'s biological parent's divorce certificate, please upload here.

Skip this if you do not have this record or is it is not applicable.
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If you have a copy of any educational records for the child(ren), please upload here.

Skip this request if you do not have this record or is it is not available to you.
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If you have copies of the child(ren)'s baptismal records or a family book entry, please upload here.

Skip this request if you do not have this record or is it is not available to you.
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Please Upload a Copy Of the Child(ren) Adoption Decree(s) If You Have It In Your Possession:

Skip this request if you do not have this record or is it is not applicable to you.
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Please Upload a Copy Of the Child(ren) Birth Certificate(s) If You Have It In Your Possession:

Skip this request if you do not have this record or is it is not available to you.
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If you have any medical records of the child(ren), please upload here

Skip this request if you do not have this record or is it is not available to you.
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Please Upload a Copy Of the Child(ren) Parents Death Certificate(s) If You Have It In Your Possession:

Skip this question if this is not applicable to your family.
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Please Upload a Copy Of the Child(ren) Termination of Parental Rights, Relinquishment of Parental Rights or an Abandonment Decree Document(s) If You Have This In Your Possession:

Skip this question if this is not applicable to your family.
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What is the name of your Primary Provider Agency (the placing agency).
If you have not contracted with a Primary Provider agency, you may skip this question.
If you have a Primary Provider Agency please enter the applicable email address.
If you have not contracted with a Primary Provider agency, you may skip this question.
Prospective Adoptive Parent #1

Clear
Date

MonthDayYear
Date
Prospective Adoptive Parent #2 (if appliacable)

Clear
Date

MonthDayYear
Date
Should be Empty: