General Information

* First Name Last Name Spouse's First Name Spouse's Last Name Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zip * Email * Phone Best Time to Reach You How did you hear of Everlasting Adoptions, Inc AOLBingFacebookGoogleMSNTwitterYahooFriends/FamilyOther

Employment History

Your Occupation Spouse's Occupation

General Descriptions

Your Date of Birth Your Race Your Hobbies, Talents and Interests Your Community Service/Activities Spouse's Date of Birth Spouse's Race Spouse's Hobbies, Talents and Interests Spouse's Community Service/Activities

Marital History

Date of Marriage

Education

Your Highest Education Attained Your Year Graduated Spouse's Highest Education Attained Spouse's Year Graduated

Financial History

(Remains Confidential)

Household Income Less than $50,000 $50,000 - $75,000 $75,000 - $100,000 $100,000 - $150,000 $150,000 - $250,000 $250,000+ Do you own or rent

Children

Please list the children in your family and indicate if the child is adopted or if the child is biological.

Personal History

Declared Bankruptcy? Yes No Been under psychiatric care? Yes No Been arrested? Yes No Received a dishonorable discharge from military service? Yes No Placed a child for adoption? Yes No Past due on any court ordered installment of child support? Yes No If you checked 'Yes' to any of the boxes above, please explain Please describe briefly your reasons for wanting to adopt

General Lifestyle Information

Please describe your home and neighborhood What do you enjoy doing together & individually? Please briefly describe how you think your life will change after adoption?

Home Study & Attorneys

If you do not have a home study we can provide a contact for you.

Do you have a completed home study? Yes No If Yes, completed by Are you signed up with any other adoption consultants, organizations, or agencies? Yes No If Yes please list their names and phone numbers

Photo

Upload a photo of you

Family Photo Upload

Read & Submit

We will let you know in 7 days or less if we can accept you into our program at this time. You will be notified via EMAIL, so please check your emails frequently. If you have difficulty submitting your application, OR if you have questions, please call us at 1-866-406-2702 or email us at: carol@everlastingadoptions.com

By clicking "Submit", you declare under penalty of perjury that the foregoing is true and correct.