Adoption Inquiry Form The purpose of this form is to refer families to appropriate agencies for adoption services and to assist agencies in the recruitment of families for Virginia's waiting children. This is not an application. If you are interested in adopting a child, you must have a completed home study as part of the adoption process. A home study will explore the proposed adoptive environment. Applicant Information Name:  * Race: Select African American American Indian Asian-American Hispanic Biracial Other Unknown White Marital Status: Select Single Married Divorced Widowed Spouse's name (if applicable): Spouse' Race: Select African American American Indian Asian-American Hispanic Biracial Other Unknown White E-mail:  * Address: City: State: Zip:  * County: Home Phone: Work Phone: Information Requested: Select Adoption Foster Care Specific Child Miscellaneous Characteristics of Child You Want to Adopt Sex Female   Male   Either Age: Select 0 mos - 6 years old 6 years - 12 years old Over 12 years old Any Age Disabled ? Yes   No   Will Consider Siblings:   Yes   No   Will Consider Race: No Preference White African American Biracial Hispanic Other Please list the names and Case Numbers (if known) of the Children you are interested in adopting: Comments: Home Study Do you already have an approved Adoptive Homestudy? Yes No If you already have an approved Adoptive Homestudy Date Completed: Agency Name: Case Worker Name: Case Worker E-mail: Agency Address: Agency City: State: Zip: Agency Phone: Send   (form # 032-02-0153-00-eng) * Required fields

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