General Inquiry Form
My name is:
*
My E-mail is
*
example@example.com
My mailing address is:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
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American Samoa
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Madagascar
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Montserrat
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Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
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Panama
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Paraguay
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Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
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Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
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Taiwan
Tajikistan
Tanzania
Thailand
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Tonga
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Tristan da Cunha
Tunisia
Turkey
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Vatican City
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Vietnam
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Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
My phone number is:
*
My Age Range is:
*
Please Select
25-35
35-45
45-55
55-65
65+
Some Countries Have Age Restrictions for Prospective Adoptive Parents
Age Range of Preferred Child
*
Country of Interest (Mark all that apply)
*
Armenia
Bulgaria
Georgia
Ghana
Guyana
Morocco (applicants must be practicing Sunni Muslims)
Pakistan and Kinship
Serbia
Trinidad & Tobago and Kinship
Ukraine
NC Home Study Services
NY Home Study Services
Preferred Gender of Child
*
Male
Female
No preference
Preferred Health of Child (Check all that apply)
*
Typical/Relatively Healthy
Minor Needs
Moderate Needs
Non-correctable Needs
Correctable Needs
Down Syndrome
Physical Disability
Developmental/intellectual Disability
Older Child
Sibling Group
I would like an application emailed to me:
Yes
No
Are you (or your spouse) a US citizen? (If you are not a US citizen, you will need to pursue an adoption through your country of origin's competent authority.)
*
Yes
No
If you are not a US Citizen, Hopscotch is unable to assist you further. Please contact your country of residence's Central Authority to assist you further.
Do you have a specific question not addressed within this form?
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