Prospective Adoptive Parents Fact Sheet

In completing this form you are expressing your interest in coming to the next Informational Meeting of Aggieland Pregnancy Outreach. As the title implies, please give us a few "facts" about yourselves. We look forward to getting to know you!

Husband
Husband First Name* *
Middle Name
Husband Last Name* *
Preferred or Nick Name
Date of Birth* *Calendar
Social Security Number
- -
Education  
If degree, what was your major?
Employer/Employment
Husband Preferred Email
Secondary Email
Work Phone
()-ext
Enter Int'l Number
Husband Cell Phone
()-ext
Enter Int'l Number
Preferred method of husband's contact  
Wife
Wife First Name* *
Middle Name
Wife Last Name* *
Preferred or Nick Name
Date of Birth* *Calendar
Social Security Number
- -
Education  
If degree, what was your major?
Employer/Employment
Wife Preferred Email
Secondary Email
Wife Cell Phone
()-ext
Enter Int'l Number
Work Phone
()-ext
Enter Int'l Number
Preferred method of wife's contact  
Joint Information
Street Address
Street Address Line 2
City
State/Region*
Enter Region
Zip Code
County
Home Phone
()-ext
Enter Int'l Number
Date of Marriage Calendar
Number of children in the home
Name and age of child(ren) if applicable
Shipping Address if different from above
Only enter Shipping Address if it is different from the Residence Address.
Shipping Street Address
Shipping City
Shipping State/Region
Enter Region
Shipping Zip Code
Church Information
Name of Church
Church Street Address
Church City
Church State
Enter Region
Church Zip
Church Office Phone
()-ext
Enter Int'l Number
Church Website
Name of Pastor
(Husband) I have read APO's statement of faith. I share the same doctrinal beliefs as APO.
If no, please describe how your beliefs differ from those of APO:
(Wife) I have read APO's statement of faith. I share the same doctrinal beliefs as APO.
After reading the information packet, do you believe you fit the eligibility requirements?
If you are "borderline" in any of the requirements, please explain your situation.
Adoptive Child
To what age or age range of child are you interested in adopting?
Are you open to adopting a child of a different race or ethnicity?
Are you involved with any other adoption service providers?
If yes, please describe
How did you find out about our program?
How did you hear about us?  
Please provide the names of the people or places that referred you so that we may thank them.
Family Photo
Photo
Photo Upload #2
If you would rather view a DVD of a previous Information Meeting instead of waiting for our next live meeting, check here and one will be mailed to you for a fee of $25 to cover our administrative and postage costs.
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.
Family Login Password*
Confirm Password *
Password must be at least 8 characters with at least one uppercase letter, one lowercase letter, and one number.
 
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