Questionnaire Thank you for your interest in our programs. We will contact you soon to provide more information on the AIS programs. (* indicates this field is required) I am interested in:* Quickstart Program Only Pathway Partnership Program Only Either Program Name(s):* Marital Status:* Single Couple - not married Married Date married: Referrred By: Contact InformationAddress: Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Email:* The best way to reach me during the day:* Phone Email Applicant OneName:* First Last Age: Race/Ethnicity: Occupation Have you been married before?*NoYesNumber of times you were married before: Have you ever been arrested?*NoYes, drug/alcohol chargeYes, other charge (non-felony)Applicant TwoName: First Last Age: Race/Ethnicity: Occupation Have you been married before?NoYesNumber of times you were married: Have you ever been arrested?NoYes, drug/alcohol chargeYes, other charge (non-felony)ChildrenI already have children:* No Yes - biological Yes - adopted Yes - both adopted and biological Yes - blended family Tell us about your children (ages, gender and if adopted agency/attorney used):Tell us about your desire to adopt:Reasons/motivations to adoptionTell us briefly about your journey to adoption, if adoption is in your family, etc.Race/Ethnicity of child I would consider adopting: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 Gender:I am open to:* Either gender Girl only* Boy only* I have a preference but I would adopt the other gender * Having a gender requirement will significantly increase your wait and may disqualify you from applying to some agencies. AIS does not accept gender requirements in our Pathway Partnership Program except under very special circumstances.Finances :Finances - Maximum budget you are willing to consider for an adoption (not including travel, home study and AIS fee)?*Select One$40,000 (firm)$40,000 - $45,000$45,000+Unsure at this time(The average budget for 2022 was $42,000. Please indicate the budget range you would consider.)Finances are:*Select Onesecuredstill being securedpartially ready/not readyWhere are you on your journey?I am:* Just starting. In research mode. Just about done researching. Already started on my own and have a home study and/or profile book already. Home Study Provider: Name of provider & date completedProfile Book: Let us know the status of your book and if you completed it or had it done professionally and by whom. Profiles can be emailed to aisteam@adoptioninfosvcs.com for review. AIS has guidelines we ask clients to follow. As an AIS client, we will review your book and recommend updates as needed.Additional Information:Please 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, etc.)? What other questions do you have?Pathway Partnership Program OnlyAIS does not guarantee that a prospective client will be accepted into the Pathway Partnership Program. If AIS determines from the review of a prospective client's application and/or home study that we will not be able to identify a placement resource who is willing to work with the prospective client given specific information in the applicant's background or the type of child the applicant wishes to adopt, etc. and/or if AIS determines that the Pathway Partnership Program is at capacity, then AIS reserves the right to deny the prospective client's acceptance into the Pathway Partnership Program and may instead offer the QuickStart Program.I have read the above statement and* I agree and wish to be only considered for the Pathway Partnership Program. I agree and would like to be considered for the QuickStart program if the Pathway Partnership Program is unavailable to me. QuickStart or Pathway Partnership ProgramAIS does not guarantee that a prospective client will be accepted into the Pathway Partnership Program. If AIS determines from the review of a prospective client's application and/or home study that we will not be able to identify a placement resource who is willing to work with the prospective client given specific information in the applicant's background or the type of child the applicant wishes to adopt, etc. and/or if AIS determines that the Pathway Partnership Program is at capacity, then AIS reserves the right to deny the prospective client's acceptance into the Pathway Partnership Program and may instead offer the QuickStart Program.I have read the above statement and* I agree and would like to be considered for either program. I agree and I would like to discuss the programs further. QuickStart ProgramThe QuickStart Program includes one private counseling sessions to be completed within one month (30 days) of the fee agreement as well as telephone and email contact for two additional months (60 days). Continuing advice and guidance beyond three months are available on an additional fee basis.I have read the above statement and* I agree Untitled Δ
