Online Application Form

Adoption Financial Assistance Application

The Omnah Foundation is a Christ-Centered 501(c)3 Ministry
Instructions:

Please fill out the form below to apply for adoption financial assistance from the Omnah Foundation. We ask that you complete it prayerfully and take your time. Please complete each section of the application. Incomplete applications will not be considered. Our board approaches each adoption consideration with fervent prayer. Know that our acceptance of your application is not a guarantee of you receiving financial assistance, but is a 100% guarantee we will continue praying for your growing family.
Applicant Eligibility:
- Christian, two-parent home
- At least one of the applicants must be a U.S. Citizen
- Must have a completed and current home study for Tier 2 application
- Must have a true need for financial assistance
- One application per adoption
- Agreement with Omnah Foundation Application Terms

Application Options
How did you hear about Omnah Foundation?*
Check the tier of assistance for which you are applying?*

Tier 1: Family Support GrantTier 2: Paid-Forward Grant
Tier 1: Family Support Grant

Families selected for Tier 1 assistance are offered a donation landing page in which all bank transaction fees are fully covered either by Omnah or by the donor if they choose to do so. The Omnah Board can decide to release funds collected through the landing page as a Family Support Grant.

Tier 2: Paid-Forward Grant

Families selected for Tier 2 assistance are offered everything in Tier 1 and are offered a Paid-Forward Grant. The idea of the Paid-Forward model accentuates the fact that any available grant monies have been paid-forward by other families and individuals. All situations are unique, but we ask all the families we partner with to prayerfully and seriously consider taking an active part however they can in paying forward to other Christian families like theirs. For example: 1.) by consistently encouraging the people in their spheres to join with us and give to support Christian adoptive families; 2.) and by becoming an active donor and giving to other adoptive families through Omnah as they can when their financial situation stabilizes.
Both Hands

Select here if you would like us to share this application information with our friends at the Both Hands Foundation to contact you about possibly doing a widow service fundraising project. Their projects the last two years have raised $22,000 on average per family. (More information at www.bothhands.org).No, thank you

About You
Adopting Father
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Country of Citizenship*

Social Media*

	Type of Account	Link / Handle
1
2
3
4
5
6

Employer*
Occupation / Position*
Employed Since*
Company / Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Adopting Mother
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Country of Citizenship*

Social Media*

	Type of Account	Link / Handle
1
2
3
4
5
6

Employer*
Occupation / Position*
Employed Since*
Company / Employer Address*

Street Address

Street Address Line 2

CityState

Zip Code
Your Family
Home Address (Mailing Address)*

Street Address

Street Address Line 2

CityState

Zip Code
What date were you married?*

MonthDayYear
Date
How many children do you currently have?*

0123456Other

Adoption Agency and Consultant
Agency
Are you Adopting Through an Agency?

YesNo
Adoption Agency
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
If you are using more than one agency, please tell us your specific adoption arrangement.
If you are not using an agency, please tell us your specific adoption arrangement.
Consultant
Are you using an Adoption Consultant?

YesNo
Organization
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Is there other information we should know about your arrangement for adoption consulting?

About Your Adoption
Type of Adoption*

DomesticInternationalOther
Age Range (check all that apply)*

0-3 yrs4-10 yrs11-18 yrs
Are you pursuing an adoption of a child who has special needs?*

YesNo
Are you open to adopting sibling groups?*

YesNo
Have you already been matched?*

YesNo
Date you were matched.

MonthDayYear
Date
When is the Birthmother's Due Date, or the Placement Date?

MonthDayYear
Date

What led you to adopt?*
Where are you in the adoption process?*
Are there other details we should know concerning your adoption?

Your Relationship With God
We would like to get to know your faith background and how the Lord has brought you to adoption!
Husband Testimony*

Please include the following: Your understanding of the gospel, your personal testimony and salvation experience, your church involvement including any volunteer positions and/or group participation.0/0
Wife Testimony*

Please include the following: Your understanding of the gospel, your personal testimony and salvation experience, your church involvement including any volunteer positions and/or group participation.0/0
What role does the Word of God have in your daily life?*

0/0
How has your Christian faith impacted your decision to adopt?*

Parenting and Educational Values
What are your family's Christian core values?*
Someday, your child will have questions about his/her life and existence. What will you teach your child(ren) about each of the three (3) topics listed below?*

1.) CREATION: How did it all begin? Where did we come from? | 2.) THE FALL: What went wrong? What is the source of evil and suffering? | 3.) REDEMPTION: What can we do about it? What is the basis and foundation of your relationship with God?0/0
How would you describe your parenting style? Tell us how you plan to lead your family in a close walk with Jesus.*

0/0
What parenting training have you received in the past, and how do you plan to continue to improve your parenting skills? Include how you plan to continually grow your parenting skills as your child ages.*
Is your child of school age?*

YesNo
What are you childcare plans?
What is your educational choice for your child?*

HomeschoolPrivate ChristianPublicOther
What are your plans to ensure a strong biblical education?*

Your Adoption Funding
Costs

Adoption Costs*

	Name of Organization / Description	Anticipated Total Cost	Amount Paid Already	Amount Remaining	Date Due (if known)
Agency Fees
Home Study
Consultant Fees
Foreign Program Fees
In-Country Fees
INS Fees
Orphanage Donation
Notarization or Authentication
Translation Fees
Travel
Visa
Other
Other
Other

Have you experienced a disrupted adoption?*

YesNo

Describe any other costs related to your adoption.
TOTAL Estimated Remaining Financial Need*
What amount is remaining that is not covered by other means
TOTAL Estimated Cost of Your Adoption*
Funding

Source of Funding*

	Description	Amount in hand	Amount anticipated	Status
Personal Funds (Savings, etc)
Employer Assistance
Fundraiser 1
Fundraiser 2
Fundraiser 3
Fundraiser 4
Fundraiser 5
Grant/Loan 1
Grant/Loan 2
Grant/Loan 3
Grant/Loan 4
Other
Other
Other

TOTAL Estimated Funding at Present*
Why is a paid-forward grant something that would be helpful at this time? Give financial details that support your thinking. Include what would be a reasonable grant amount? Why?
Why is a grant something that would be helpful at this time? Give financial details that support your thinking.

Household Financial Statement
Income

Total Combined Annual Income
Total Combined Monthly Income
Expenses

Total Monthly Expenses
Monthly Cash Flow
Assets

Total Liquid Assets

Total Investments

Total Durable Goods

Total Real Property
Total Assets
Liabilities

Total Property Debt

Total Personal Debt
Total Liabilities
Total Net Worth

	Amount
Head of Household Annual Income
Spouse Annual Income
Investment Income
Other Income

	Amount
Tithe & Charitable Giving
Placed in Savings
Housing or Rent Payment
Other Mortgage Loan Payment(s)
Equity Loan Payment(s)
Vehicle and Auto Loan Payment(s)
Student Loan Payment(s)
Other Loan Payment(s)
Credit Card Balance Payment(s) for Outstanding Debt
Utilities
Groceries
Transportation (gas, repairs, taxi, etc)
Housewares and Clothing
Healthcare or Medications
School Tuition
Paid Alimony
Paid Child Support
Paid Child Care
Health or Dental Insurance
Auto Insurance
Life Insurance
Other Insurance
Other Expenses

	Amount
Checking Accounts
Savings Accounts
Other

	Amount
Retirement Plans, Pension Plans
Mutual Funds, Bonds, Stocks and Trusts
Other Investments

	Amount
Household Furnishings
Vehicles
Boats, Motorcycles, and Recreational Equipment
Other Possessions

	Amount
Primary Home/Personal Residence
Business Property and Real Estate
Other Real Property

	Amount
Home Loan for Primary Home
Other Home/Land Loans
Vehicle and Auto Loans

	Amount
Home Equity Loan Balance
Student Loans Balance
Outstanding Credit Card Debt Balance
Other Loans and Liabilities

Connect Us With Your References
Pastor Reference

PLEASE NOTE: Attach a reference letter below. Also, shortly after you submit this application, an automated reference request will be sent to this person at the email address you enter which asks them to complete a short online reference form on your behalf.
Pastor Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Church Name*
Church City/Location*
Length of Membership*
If you have been a member with your current church body for 3 years or fewer, please let us know the contact information for your previous church below.
Pastor Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Church Name*
Church City/Location*
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Church Leader or Accountability Partner Reference

PLEASE NOTE: Attach a reference letter below. Also, shortly after you submit this application, an automated reference request will be sent to this person at the email address you enter which asks them to complete a short online reference form on your behalf.
Church Leader or Accountability Partner Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Cancelof
Personal Reference

PLEASE NOTE: Attach a reference letter below. Also, shortly after you submit this application, an automated reference request will be sent to this person at the email address you enter which asks them to complete a short online reference form on your behalf.
Personal Reference*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Cancelof

Upload Files
Home Study
Do you have a completed home study?*

YesNo
Organization*
Contact Name*
Contact Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Cancelof
Where are you in the process of obtaining a completed home study?*
Tax Return - Form 1040
Submit a copy of the first 2 pages of your most recent tax return. Example Form
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Credit Report
Your credit report can be obtained for free and should be dated within the last 90 days. Here are instructions for how to get a credit report if you do not already have a recent one.
Cancelof
Family Photo

(accepted formats - jpg, jpeg, png, gif, heic)
Cancelof
Additional Supporting Documents

(Optional)
Cancelof

Statement of Faith Agreement
Statement of Faith:
- WE BELIEVE the Bible is God's written revelation to mankind, divinely given through human authors who were inspired by the Holy Spirit. It is completely authoritative, and entirely true.
- WE BELIEVE that there is one God, eternally existent in three persons: Father, Son and Holy Spirit. We believe that Jesus is God, in equal standing with the Father and the Holy Spirit.
- WE BELIEVE in the deity of Jesus Christ who existed as God before anything was created, His virgin birth, sinless life, miracles, death on the cross to provide for our redemption, bodily resurrection and ascension into heaven, present rule as the Head of the Church, ministry of intercession for us and His personal return to earth in power and glory. He is the world's only Savior and is the Lord of all.
- WE BELIEVE that man was created in the image of God, but that through sin, he brought upon himself and his posterity not only physical death, but also spiritual death which is separation from God, and because of this all people everywhere are born lost and face the judgment of God.
- WE BELIEVE that the salvation of lost and sinful man is a free gift of God’s grace apart from works, is effected by the Holy Spirit who brings about regeneration and the repentance of sin, and is received through faith by trusting in Christ’s finished work on the cross. The veracity of this faith will be evidenced in the conduct of each believer.
- WE BELIEVE in the personality and deity of the Holy Spirit, in His present ministry, that He performs the miracle of new birth in an unbeliever, and that He indwells believers, enabling them to live a godly life.
- WE BELIEVE in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are unsaved unto the resurrection of eternal punishment and separation from God.
- WE BELIEVE that marriage is a life-long sacred covenant before God and man between one man and one woman instituted by God from the beginning of Creation.
Do you both personally agree and attest to the following?
- My sin separated me from God.
- My sin is forgiven only through faith in Christ and his atonement for my sin.
- My relationship with the Lord is because of His grace and mercy.
- Belief in Jesus Christ is the only way to salvation and eternity in heaven.
- The evidence of my faith in Christ will be seen by changed life and works that glorify the Father.
Personal Statement of Faith*

We both personally agree with the statements above and attest to a personal relationship with Jesus
Statement of Faith Agreement*

As a family, we share this statement of faith

Agreement and Signature
AGREEMENT

By signing and clicking “Submit” you are agreeing to the following:
- We have read and agree with the Omnah Foundation Statement of Faith
- We have read and agree to the Omnah Foundation Privacy Policy.
- We have read and agree to the Omnah Foundation Code of Applicant Conduct.
- We meet the eligibility requirements which are listed at the beginning of the grant application and on the Omnah Foundation website.
  - Christian, two-parent home
  - At least one of the applicants must be a U.S. Citizen
  - Must have a completed and current home study
  - Must have a true need for financial assistance
  - One application per adoption
- We hereby give consent for Omnah Foundation to contact our adoption agency and any other person or institution named in this application and we authorize such persons and institutions to release information to Omnah Foundation. We also understand and agree that Omnah Foundation is not obligated to provide financial assistance based on the willingness to accept an application.
- We agree that whether or not financial assistance is provided is at the total discretion of the ministry and its representatives.
- We agree to share our adoption story, to be interviewed by Omnah Foundation, to write a thank-you note to donors whose gift enables financial assistance, and to be open to provide pictures and updates with the purpose of advocating for adoption and helping more families adopt. (If there are restrictions on the use of our information or pictures we will communicate this to Omnah in writing)
- All of the details provided in this application and supplemental documents are true, accurate, and complete to the best of our knowledge.
- We agree that any unused portion of potentially awarded assistance will revert back to the Omnah Foundation.
- We agree and Omnah is not obligated to provide any assistance to us through grants or loans.
Adopting Father Signature*

Clear
Adopting Mother Signature*

Clear

Here to reveal submit button
Should be Empty:

	Name	Age	Biologically	Through Adoption
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6

	Child Name	Age	Gender	Location
Child 1
Child 2
Child 3
Child 4

	Agency	State/Country	Date	Approximate Financial Loss
Disrupted Adoption 1
Disrupted Adoption 2
Disrupted Adoption 3

Adoption Financial Assistance Application

Adopting Father

Adopting Mother

Your Family

Agency

Consultant

Costs

Funding

Income

Expenses

Assets

Liabilities

Pastor Reference

Church Leader or Accountability Partner Reference

Personal Reference

Home Study

Tax Return - Form 1040

Credit Report

Family Photo

Additional Supporting Documents