Hosting Application

Thank you for viewing our website and for your interest in Nightlight Christian Adoptions Hosting Program.  If you have seen a child on our website or through KIDSAVE that you would like to host, we request that you complete our hosting application below.  After you have filled out all the necessary information, please submit it for our review.  Your information is held confidential on our secure site.  Under normal circumstances, we will be in touch with you either by e-mail or telephone within two days of receiving your application.
 
We understand that the information asked can seem overwhelming.  Please know that the purpose of asking you to provide the information is for us to further assist you in the hosting process.  We want our clients to be successful, so if there is something identified through this initial paperwork that may be a barrier to you being able to host or later, adopt, we want to identify it early on so it can be discussed.  Specifically when hosting or adopting internationally, different countries have various eligibility requirements that need to be met.  Your information will determine which programs may be successful for you.  

"I will not leave you as orphans; I will come to you" (John 14:18, NIV).

 

Host Father Legal Last Name* * Legal First Name* * Legal Middle Name Preferred Name Other Known Names Date of Birth* * Birth Place (city, state, country) 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 States of America Unknown White or Caucasian White/Caucasian   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   Residence 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 County Host Father Contact Home Phone ()-ext Enter Int'l Number Cell Phone* ()-ext Enter Int'l Number Email* Work Phone ()-ext Enter Int'l Number Work Fax ()-ext Enter Int'l Number 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   Host Father Height/Weight Height (in) Weight (lbs) BMI Go to http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm and calculate your Body Mass Index. If it is 40 or higher, please comment on how your weight affects your blood pressure, cholesterol, mobility or other aspects of daily living. Host Father ID Driver License # State of Issue 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 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 Host Father Employment Occupation Employer Work City Work 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 Salary Last Year $ Current Annual Salary $ Host Father Religion 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   Church Affiliation Active? YesNo

Host Mother Legal Last Name* * Legal First Name* * Legal Middle Name Preferred Name Other Known Names Date of Birth* * Birth Place (city, state, country) 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 States of America Unknown White or Caucasian White/Caucasian   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   Mailing Address Enter only if it is different from Residence 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 Host Mother Contact Family Fax Number ()-ext Enter Int'l Number Cell Phone ()-ext Enter Int'l Number Email* Work Phone ()-ext Enter Int'l Number Work Fax ()-ext Enter Int'l Number 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   Host Mother Height/Weight Height (in) Weight (lbs) BMI Go to http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm and calculate your Body Mass Index. If it is 40 or higher, please comment on how your weight affects your blood pressure, cholesterol, mobility or other aspects of daily living. Host Mother ID Driver License # State of Issue 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 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 Host Mother Employment Occupation Employer Work City Work 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 Salary Last Year $ Current Annual Salary $ Host Mother Religion 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   Church Affiliation Active? YesNo Family Photo If you do not have a digital photo available, please mail a photo to our office. Once uploaded, your photos will be viewable by agency staff only. Family Photo 1 Document Uploaded Upload New/Replace Existing Family Photo 2 Document Uploaded Upload New/Replace Existing

Father's Information Have you ever failed to meet your child or spousal support obligation? Yes No NA  Has any child ever been removed from your care due to abuse or neglect? YesNo Have you ever been deprived of parental rights or had your rights restricted? YesNo Have you ever been charged or accused of child abuse or neglect? YesNo If yes, please explain* * Have you been accused of, or charged with, sexual abuse against another (even if there was no conviction)? YesNo If yes, explain. Have you been diagnosed or received treatment for a mental health condition? YesNo If Yes, please explain* * Do you have a history of drug use? YesNo If yes, please state the drug that was used and your age at the time. Have you ever been treated for drug or alcohol abuse? YesNo If yes, please explain* * Do you have a history of domestic violence? Do you have more than 4 traffic law violations? Please list. Have you ever been denied a homestudy? YesNo If yes, please explain* * Have you ever been given an unfavorable homestudy? YesNo If yes, please explain* * Have you ever begun a homestudy that was never completed? YesNo If yes, please explain* * Have you ever filed bankruptcy? YesNo If yes, please explain* * Do you currently use any legal or illegal drugs, such as, marijuana? YesNo

Mother's Information Have you ever failed to meet your child or spousal support obligation?* Yes No NA  Has any child ever been removed from your care due to abuse or neglect?* YesNo Have you ever been deprived of parental rights or had your rights restricted?* YesNo Have you ever been charged or accused of child abuse or neglect?* YesNo If yes, please explain* * Have you been accused of, or charged with, sexual abuse against another (even if there was no conviction)? YesNo If yes, explain. Have you been diagnosed or received treatment for a mental health condition?* YesNo If Yes, please explain* * Do you have a history of drug use? YesNo If yes, please state the drug that was used and your age at the time. Have you ever been treated for drug or alcohol abuse?* YesNo If yes, please explain* * Do you have a history of domestic violence?* Do you have more than 4 traffic law violations? Please list.* Have you ever been denied a homestudy?* YesNo If yes, please explain* * Have you ever been given an unfavorable homestudy?* YesNo If yes, please explain* * Have you ever begun a homestudy that was never completed?* YesNo If yes, please explain* * Have you ever filed bankruptcy?* YesNo If yes, please explain* * Do you currently use any legal or illegal drugs, such as, marijuana? YesNo

Failure to disclose or fully explain any requested information, or lack of candor or honesty in answering the questions on this application may result in your disqualification without refund of any fees paid.

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