Application Form

Welcome to the online application. We have tried to make the process as simple as possible for you. The application is a little lengthy, so you will probably want to save it and come back at another time. Please create a login and password and remember to click “Submit” as you work to be sure you don’t lose anything. By clicking “Submit,” your info is safely stored in our database.

Before you exit, click “Submit” again. When you want to log back in and finish the application, come back to the application page on our website and enter the login information you created. The draft you saved will be there to continue your application where you left off. After completing all sections of the application you can “Submit” your completed application.

INSTRUCTIONS:

Attach photocopies of adoptive mother and adoptive father's birth certificates.
Attach a photocopy of your marriage certificate and (when applicable) your divorce decree.
Complete a statement of faith by the adoptive mother and adoptive father.
Attach one family photo (including adoptive mother and father and children, if any).
All information must be complete for this application to be processed.
Application fee ($400), which is not refundable, is due with this application. If the application is for the Poland program please add an additional ($75) for initial program costs.

*ALL INFORMATION PROVIDED WILL BE HELD IN THE STRICTEST OF CONFIDENCE.

We may be able to save you time by pre-filling the form with the information that you have previously entered.

Have you previously submitted your information to us?

Yes, Login

No, Begin Form

Password
Please enter a password so that you can save and come back to complete your Application at a later time.
Family Login Password	Password Already Set Change Password
Confirm Password
Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, one number, and one special character.

Program
Program You Are Applying To Adopt From:*

Adoptive Father

Father Last Name*

Father First Name*

Father Middle Name

Father Cell Phone

()-ext

Enter Int'l Number

Father Email

Father Preferred Contact Method

Adoptive Mother

Mother Last Name*

Mother First Name*

Mother Middle Name

Mother Maiden Name

Mother Cell Phone

()-ext

Enter Int'l Number

Mother Email

Mother Preferred Contact Method

Family Address

Street Address

Street Address Line 2

City

State/Region*

Enter Region

Zip Code

County

Country

Show All Countries

Contact

Preferred Contact Method

Home Phone

()-ext

Enter Int'l Number

Home Email*

Fax Number

()-ext

Enter Int'l Number

Family Photo
If you do not have an electronic photo available, please mail a photo to our office (labeled with your name and contact information).
Photo
Photo Upload #2

Document Upload
Marriage Certificate Document	Document Uploaded Upload New/Replace Existing
Adoptive Father Divorce Decree Documents	Document Uploaded Upload New/Replace Existing
Adoptive Mother Divorce Decree Document	Document Uploaded Upload New/Replace Existing
Adoptive Father Birth Certificate Document	Document Uploaded Upload New/Replace Existing
Adoptive Mother Birth Certificate Document	Document Uploaded Upload New/Replace Existing
Commitment Documents Part 1	Document Uploaded Upload New/Replace Existing
Commitment Documents Part 2	Document Uploaded Upload New/Replace Existing

Housing
Type of Home	Apartment House
How Long?
Number of Bedrooms
Rent or Own?	Own Rent

Adoptive Father General Information

Father Occupation

Father Employer

Father Work Street Address

Father Work City

Father Work State/Region

Enter Region

Father Work Zip Code

Father Work Phone

()-ext

Enter Int'l Number

Father Employed Since

Father Annual Income

Father DOB*

Father Birthplace

Father Citizenship

Show All Countries

Ancestry

Hair Color

Eye Color

Height

Enter in inches (in)

Weight

Enter in pounds (lbs)

Complexion

Health

Excellent

Fair

Good

Poor

Hobbies

Father Race

Father Religion

Adoptive Mother General Information

Mother Occupation

Mother Employer

Mother Work Street Address

Mother Work City

Mother Work State/Region

Enter Region

Mother Work Zip Code

Mother Work Phone

()-ext

Enter Int'l Number

Mother Employed Since

Mother Annual Income

Mother DOB*

Mother Birthplace

Mother Citizenship

Show All Countries

Ancestry

Hair Color

Eye Color

Height

Enter in inches (in)

Weight

Enter in pounds (lbs)

Complexion

Hobbies

Health

Excellent

Fair

Good

Poor

Mother Race

Mother Religion

Recent Home Study
Do you have a recent Home Study?*	YesNo
If yes, date completed
Name of Home Study Agency
Address of Home Study Agency

Family Questions
If Applicants have different religions, what religion would child be reared?

Christian Denomination
Formal name of church with which you are affilated
How long have you been looking to adopt?
How did you hear about of An Open Door?
Marital Status
If married, Date of Marriage
Place of Marriage
Father Prior Divorces Number
Mother Prior Divorces Number
Why do you desire to adopt?

Have you been diagnosed with infertility?
YesNo
Would you like to expand on whether or not you have been diagnosed with infertility? (Optional)

Adoptive Father States/Countries of Residence Since 18 Years Old

Please list all countries and states which Ap 1 has lived in, even if it was only for a few months.

How many Countries or States has Father lived in since 18 years old?

Adoptive Mother States/Countries of Residence Since 18 Years Old

Please list all countries and states which Ap 2 has lived in, even if it was only for a few months.

How many Countries or States has Mother lived in since 18 years old?

Education

Family Details - Academic History

Father or Mother	Degree	Major	Name of College	Date of Graduation

Financial Summary
Savings
Real Estate Market Value
Equity in Real Estate
Rental Income
Other Investments
Mortgage Payments Monthly
Mortgage Balance
Other Income
Ap #1 Life Insurance Value
Ap #2 Life Insurance Value

Father
Have you been, or are you currently, under treatment for any medical, psychiatric or emotional condition within the last five (5) years?
YesNo

Mother
Have you been, or are you currently, under treatment for any medical, psychiatric or emotional condition within the last five (5) years?
YesNo

Medical Conditions

Family Details - Medical Conditions

Medications

Family Details - Medications

Adoptive Father's Statement of Faith
Please provide your personal response to each of the following questions regarding your faith. A separate response is requested for each adoptive parent.
What is the significance of Jesus Christ in your life?

Describe how you became a Christian.

Describe your spiritual growth since becoming a Christian.

Describe your involvement and participation in spiritual activity.

In what way do you think Christianity is different from other religions that also encourage good deeds, moral conduct, and brotherly love?

How does your Christian commitment affect your future responsibilities as a parent?

Adoptive Mother's Statement of Faith
Please provide your personal response to each of the following questions regarding your faith. A separate response is requested for each adoptive parent.
What is the significance of Jesus Christ in your life?

Describe how you became a Christian.

Describe your spiritual growth since becoming a Christian.

Describe your involvement and participation in spiritual activity.

In what way do you think Christianity is different from other religions that also encourage good deeds, moral conduct, and brotherly love?

How does your Christian commitment affect your future responsibilities as a parent?

References

PLEASE LIST 6 REFERENCES (NAMES, COMPLETE ADDRESS, ZIP & PHONE NO)

Note: If applicant has worked with children in the past 5 years a reference from that employer must be included.

Pastor
Employer (Husband's if employed)
Employer (Wife's if employed)
Neighbor
Extended Family Member
Friend.

PLEASE LIST 6 REFERENCES

An Open Door or their authorized representative is hereby permitted to contact the above named references. They will be sent a short questionnaire evaluating you as adoptive parent(s).

Application Form Complete
When you have finished answering the questions on this application form in full, please check this box to notify our team. Once application is submitted, please allow 2-3 business days for instructions on how to pay your application fee.
Application Form is complete

Statement of Understanding
	I affirm that by submitting this adoption application that the information provided is true and accurate. I further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime. Additionally, I understand that approval of this application does not guarantee approval of a home study or a placement of a child. INVESTIGATION AUTHORIZATION We hereby authorize An Open Door Adoption Agency, Inc. or its representatives, to pursue any investigation it deems necessary in order to properly evaluate us as an adoptive family. We understand and agree that at times it may require independent investigations conducted by personnel hired by An Open Door Adoption Agency, Inc. We also authorize An Open Door Adoption Agency, Inc. or its representatives to submit applications, documents, requests, etc. on our behalf to further our adoption process as is needed. In doing so, we also ask that all entities respond and assist An Open Door as our agents in this adoption.I affirm that by submitting this preliminary adoption application that the information provided is true and accurate. I further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime. Additionally, I understand that approval of this application does not guarantee approval of a home study or a placement of a child.

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Submitting...

An Open Door Adoption Agency, Inc. P.O. Box 4 218 E. Jackson Street Thomasville, Georgia 31799

	Father or Mother	Name of Ex-Spouse	Divorce Date	When & Where	How Terminated

	Children	Number of Children and Ages	Where Children Reside
	YesNo

	Father or Mother	Name of Ex-Spouse	Divorce Date	When & Where	How Terminated

	Children	Number of Children and Ages	Where Children Reside
	YesNo

	Father or Mother	Name of Ex-Spouse	Divorce Date	When & Where	How Terminated

	Father or Mother	Describe conditions and reason for treatment	Date diagnosed

	Treatment Received	Name, address, phone number of doctor, therapist, counselor, etc	Medication, if any

	Father or Mother	Medication Name	Medication Classification	Reason for Medication