Adoption Questionnaire Complete the Adoption Questionnaire to begin your adoption journey with AIS. Applicant One Name: First Last Applicant Two Name: First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone:Referrred By: Date of Marriage: MM slash DD slash YYYY Email Age & Sex of Children in your Family(Please Indicate if your child(ren) is(are) biological or adopted. )Applicant OneName First Last Age Race Do you speak another language? Yes No What language(s) ? Cell PhoneEmail Occupation Annual Income Religious Affiliation Active Religious Member Yes No Number of Previous Marriages Infertility an Issue? Yes no Have you ever been arrested? Yes No If YES (arrested), when and what were the charges?Applicant TwoName First Last Age Race Do you speak another language(s)? Yes No What language(s)? Cell PhoneEmail Occupation Annual Income Religious Affiliation Active Religious Member Yes No Number of Previous Marriages Infertility an Issue? Yes no Have you ever been arrested? Yes No If YES (arrested), when and what were the charges?Career PlansCareer plans for parents after adoption.(i.e. take a leave of absence, return to work, full-time, part-time, or stay at home)Race of Child:Caucasian Yes No Not Sure Hispanic Yes No Not Sure Hispanic/Caucasian Yes No Not Sure African American Yes No Not Sure African American/Caucasian Yes No Not Sure Native American Yes No Not Sure Native American/Caucasian Yes No Not Sure Asian Yes No Not Sure Asian/Caucasian Yes No Not Sure Finances & Travel:Finances - Maximum budget you are willing to consider for your adoption (not including travel, home study and AIS fee)?Select One$40,000.00$40,000 - $45,000$45,000.00+Unsure at this time(The average budget for 2020 was $42,000. Please indicate the budget range you would consider.)Finances areSelect Onesecuredstill being securedpartially ready/not readyIf required, could you and/or your spouse travel? Maximum time you could be away Openess:Level of Openness between Adoptive Parents and Birth Parent:(Most of our clients are open to "semi-open confidential." They are willing to prepare a non-identifying profile; open to meeting birth parent before the adoption; and sharing letters/pictures through the agency after the adoption. Please comment on your comfort level with the above)Where are you/we in your/our journey?Untitled I/We are just starting. I/We are in research mode. I/We are just about done researching. I/We have already started on my/our own and have a home study and/or profile book already. Additional InformationPlease tell us anything else about yourself or the child you would like to adopt that will assist us in understanding you. What is most important to you in pursuing this adoption (i.e., time frame, cost, age of the child, your ability to travel, etc.)? If you already have a home study, please list the agency for your home study and month/year completed. If you have already completed a profile, let us know if you had it professionally completed. Profiles can be emailed to firstname.lastname@example.org for review.