Getting Started with Your Adoption...

Congratulations! You are about to take the first step toward determining the type of adoption program that is right for your family! You may already have a particular program in mind. This INQUIRY FORM will help us answer your questions.

We will contact you within 2 business days. We wish you God’s richest blessings as you seek to build your family in His time.

Password Please enter a password to use at a later time to access other forms on our website. Please write down and keep this password in a safe place. Password* Password Already Set Change Password Confirm Password * Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number. Prospective Adoptive Father First Name* * Last Name* * Cell Phone ()-ext Enter Int'l Number Email Preferred Contact Method Other Phone Home Phone Work Phone Email Work Email Cell Phone Do Not Contact Either phone number is fine Home Email Mother Email   Prospective Adoptive Mother Legal First Name* * Legal Last Name* * Cell Phone ()-ext Enter Int'l Number Email Preferred Contact Method Other Phone Home Phone Work Phone Email Work Email Cell Phone Do Not Contact Either phone number is fine Home Email Mother Email   Family Address Street Address Street Address Line 2 City State/Region* AK - Alaska AL - Alabama AR - Arkansas AS - American Samoa AZ - Arizona CA - California CO - Colorado CT - Connecticut DC - District of Columbia DE - Delaware FL - Florida FM - Federated States of Micronesia GA - Georgia GU - Guam HI - Hawaii IA - Iowa ID - Idaho IL - Illinois IN - Indiana KS - Kansas KY - Kentucky LA - Louisiana MA - Massachusetts MD - Maryland ME - Maine MH - Marshall Islands MI - Michigan MN - Minnesota MO - Missouri MP - Northern Mariana Islands MS - Mississippi MT - Montana NC - North Carolina ND - North Dakota NE - Nebraska NH - New Hampshire NJ - New Jersey NM - New Mexico NV - Nevada NY - New York OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania PR - Puerto Rico PW - Palau RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VA - Virginia VI - Virgin Islands VT - Vermont WA - Washington WI - Wisconsin WV - West Virginia WY - Wyoming Enter Region Zip Code Country United States Albania Bulgaria Burkina Faso China Colombia Ethiopia Ghana Haiti Honduras Hong Kong India Kazakhstan Kyrgyzstan Latvia Mexico Nicaragua Nigeria Panama Peru Romania Russia Taiwan Uganda Ukraine United Kingdom Show All Countries Contact Home Phone ()-ext Enter Int'l Number Email*

Father General Information Current Annual Salary $ Religion Agnostic Amish Atheist Baptist Buddhist Catholic Christian Episcopalian Hindu Islam Jewish Latter Day Saints Lutheran Mennonite Methodist No Religion Non-Denominational Other Pentecostal Presbyterian Scientology Seventh Day Adventist   Education High School Diploma/GED Some College Associates Degree Masters Degree Bachelors Degree Doctoral Degree Postdoctoral Degree Professional/Vocational Dropped out before High School In School Juris Doctorate Medical & Graduate School Medical School Ph.D. Some High School Technical College Certificate Technical School   Citizenship United States Albania Bulgaria Burkina Faso China Colombia Ethiopia Ghana Haiti Honduras Hong Kong India Kazakhstan Kyrgyzstan Latvia Mexico Nicaragua Nigeria Panama Peru Romania Russia Taiwan Uganda Ukraine United Kingdom Show All Countries Date of Birth Race American Indian or Alaska Native Asian Black or African American Hispanic or Latino Multiracial/Other Native Hawaiian or Other Pacific Islander White or Caucasian   Have you ever been arrested? YesNo Current Health Status Excellent Good Fair Poor   Have you ever been treated for drug or alcohol abuse? YesNo Have you been diagnosed with or received treatment for a mental health condition? YesNo Mother General Information Current Annual Salary $ Religion Agnostic Amish Atheist Baptist Buddhist Catholic Christian Episcopalian Hindu Islam Jewish Latter Day Saints Lutheran Mennonite Methodist No Religion Non-Denominational Other Pentecostal Presbyterian Scientology Seventh Day Adventist   Education High School Diploma/GED Some College Associates Degree Masters Degree Bachelors Degree Doctoral Degree Postdoctoral Degree Professional/Vocational Dropped out before High School In School Juris Doctorate Medical & Graduate School Medical School Ph.D. Some High School Technical College Certificate Technical School   Citizenship United States Albania Bulgaria Burkina Faso China Colombia Ethiopia Ghana Haiti Honduras Hong Kong India Kazakhstan Kyrgyzstan Latvia Mexico Nicaragua Nigeria Panama Peru Romania Russia Taiwan Uganda Ukraine United Kingdom Show All Countries Date of Birth Race American Indian or Alaska Native Asian Black or African American Hispanic or Latino Multiracial/Other Native Hawaiian or Other Pacific Islander White or Caucasian   Have you ever been arrested? YesNo Current Health Status Excellent Good Fair Poor   Have you ever been treated for drug or alcohol abuse? YesNo Have you been diagnosed with or received treatment for a mental health condition? YesNo Are you currently, or have you ever, pursued in vitro fertilization (IVF)? YesNo If yes, do you currently have one or more embryos in frozen storage? YesNo Current Marriage If married, Date of Marriage (Must be married at least 2 years before application can be accepted, and 3 years before placement of a child. Varies from country to country. Check country requirements. Previous Home Studies Have you ever begun a home study that was never completed? YesNo If yes, please explain Have you ever been denied a home study? YesNo

Previous Marriages

Select the number of previous marriages for both Applicant(s) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Other Person in Home Other Person In Home #2

Children Information

Do you (or your spouse) have any children?

Number of children 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

	First Name*	Last Name*	Birth Date	Gender	Adopted, Biological or Foster*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological Foster

Adoptive Child Preferences Which program are you interested in? Domestic infant Foster Adoption Foster Care Home Study Only International Renewed Hope (adoption from dissolution) Snowflakes Embryo Adoption   Country of Interest United States Albania Bulgaria Burkina Faso China Colombia Ethiopia Ghana Haiti Honduras Hong Kong India Kazakhstan Kyrgyzstan Latvia Mexico Nicaragua Nigeria Panama Peru Romania Russia Taiwan Uganda Ukraine United Kingdom Show All Countries Would you be willing to adopt a child with moderate to severe physical handicaps? Yes No Undecided  Child Pref Min Age Newborn 1 Year 1.5 Years 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 1 12 15 2 3 4 5 6 7 9   Child Pref Max Age Newborn 1 Year 1.5 Years 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 1 12 15 2 3 4 5 6 7 9   Desired Race Middle Eastern African African American Asian Bi-Racial Caucasian Hispanic Native American East Indian Pacific Islander   Check all that you are open to adopting. Number of Children Desired Gender Preference Boy Either Female Only Girl Male Only   Are you open to adopting a sibling group? Yes No Undecided  Any other comments regarding child(ren) desired?

Comments How did you hear about Nightlight Christian Adoptions?* Adoption Bridge adoption.state.gov Adoptive Family (Please specify below) Agency (Please specify below) Attorney (Please specify below) Church (Please specify below) Client Referral (Please specify below) Clinic (Please specify below) Conference (Please specify below) Country's Central Authority Creating a Family Embryo Adoption Awareness Center Family Member Focus on the Family Friend (Please specify below) Home Study Provider (Please specify below) Host Family (Please specify below) Internet Search (Please specify below) Magazine (Please specify below) Medical Professional (doctor, nurse, midwife, etc.) National Down Syndrome Adoption Network National Embryo Donation Center News Newspaper Online Group (Please specify below) Other (Please specify below) Pregnancy Resource Center (Please specify below) Radio Spot Returning Client Snowflake Embryo Adoption Social Media (Please specify below) Support Group Telephone Book Television Waiting Children Constant Contact Yellow Pages YouTube   Please provide the name of the specific persons or places

Statement of Understanding
	I/We affirm that by submitting this Inquiry Form that the information provided is true and accurate. I/We further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime.

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