Readiness Survey - Outgoing USA Newborn Program

Readiness Survey

International Prospective Parent(s)
Applicant

First NameLast Name
Co-Applicant

First NameLast Name
Relationship Status
Email
example@example.com
Phone Number

Area CodePhone Number
Country of Origin
If you responded "other", what is your Country of Origin?
How did you hear about Premier?
1. Do you have a completed home study and provisional approval from your Central Authority?
2. Do you have a Family Profile Book Completed?
3. Are you gender specific?
4. Are you specific about the race of your child?
5. How open are you to prenatal alcohol exposure? Please mark all that apply.
6. How open are you to prenatal drug exposure? Please mark all that apply
7. Are you open to adopting a child whose parent(s) have a history of mental illness?
8. Birth mother living expenses are common. Are you open to paying for her expenses if necessary?
9. If yes, please specify the maximum amount that you are open to?
Please provide any additional information that will help us get to know your family and your child preferences better.
10. After placement, are you open to communicating with the birth parent(s)? Mark all that apply:
Should be Empty: