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 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   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 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 Home Email*

Father General Information Current Annual Salary $ Religion Christian Agnostic Amish Atheist Baptist Buddhist Catholic Episcopalian Hindu Islam Jewish Latter Day Saints Lutheran Mennonite Methodist No Religion Non-Denominational Presbyterian Scientology Seventh Day Advantist Other Pentecostal   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 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 African African - Ethiopian African American African American/Caribbean American American Indian or Alaska Native Asian Asian/Caucasian Black or African American British Caucasian Caucasian/African American Caucasian/Asian American Caucasian/Hispanic Caucasian/Hispanic/African American Chinese European Hispanic Hispanic or Latino Hispanic/African American Indian Japanese Kazak Middle Eastern Multiracial/Other Native Hawaiian or Other Pacific Islander Other Roma Russian Sierra Leonean Spanish United State of America Unknown White or Caucasian White/ 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 or received treatment for a mental health condition? YesNo Mother General Information Current Annual Salary $ Religion Christian Agnostic Amish Atheist Baptist Buddhist Catholic Episcopalian Hindu Islam Jewish Latter Day Saints Lutheran Mennonite Methodist No Religion Non-Denominational Presbyterian Scientology Seventh Day Advantist Other Pentecostal   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 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 African African - Ethiopian African American African American/Caribbean American American Indian or Alaska Native Asian Asian/Caucasian Black or African American British Caucasian Caucasian/African American Caucasian/Asian American Caucasian/Hispanic Caucasian/Hispanic/African American Chinese European Hispanic Hispanic or Latino Hispanic/African American Indian Japanese Kazak Middle Eastern Multiracial/Other Native Hawaiian or Other Pacific Islander Other Roma Russian Sierra Leonean Spanish United State of America Unknown White or Caucasian White/ 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 or received treatment for a mental health condition? 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 homestudy that was never completed? YesNo If yes, please explain Have you ever been denied a homestudy? YesNo Have you ever had an abortion? 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 Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

	Father or Mother	Date of Marriage	Divorce Date	Reason for Divorce
	Father Mother Member of Household #1 Household Member Husband Member of Household #2 Wife

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 or Biological*	Where child resides (with us, other parent, etc)
				Male Female No Preference	Adopted Biological

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 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   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   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 Either Female Only 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 Agency Adoption Bridge Adoption Conference Adoption Now Podcast Adoption.com Adoptive Families Adoption Guide Adoptive Families Magazine Adoptive Family Another Agency Attorney Bing search Church Classroom Presentation by staff Client Referral (please specify below) Clinic Country's Central Authority Designated - Brought by Adoptive Family (please specify below) Designated - brought by Birth Parent (please specify below) Doctor Embryo Adoption Awareness Center Facebook Fairfax CryoBank Family Member Focus on the Family Friend Google Search His Little Feet Home Study Provider Host Family Internet Search Internet Search Engine Magazine Maternity Home Medical Professional (nurse, midwife, etc.) Morgan Hill Children Foundation MSN Search Multiples Group MyBabysFamily.com MyPregnancyMyFuture National Down Syndrome Adoption Network National Embryo Donation Center Newspaper Ad Orphanage Other Pastor Precious.org Pregnancy Center Pregnancy Resource Center Previous Client Radio Spot Rainbowkids Reece's Rainbow Research Returning Client Saw Building Sign School Employee SENNIAF Social Worker Support Group Telephone Book Television The Adoption Guide Waiting Children Constant Contact Women's Shelter Yahoo! Search Yellow Pages   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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