Approved Adoptive Family Interest Form
Note: This interest form is for families who have a current home study and are approved to adopt within their state. Please fill out the form completely. The family and agency caseworker information is very important at this first step. Please make sure you have your caseworkers correct phone and email address.
We receive a high volume of inquiries so we may need to communicate with your caseworker first. If your family is considered for this child or sibling group, your caseworker will be asked to send in your home study.
All fields marked with an asterisk (*) are required
 
* Agency Name:
 
Agency Address:
* Address Line 1:
Address Line 2:
* City:
* State:
* Zip Code:
 
Your Caseworker Information
* Case Worker's First Name:
* Case Worker's Last Name:
* Case Worker's Phone Number: ( ) - Ext.
Case Worker's E-mail:
 
Your Family Information
* First Name:
* Last Name:
* Your Date Of Birth:    
* Daytime Phone (Mon.- Fri., 8AM-5PM Eastern): ( ) - Ext.
Other Phone: ( ) - Ext.
Best Time to Call:
8-12 Noon - Morning
1-5 PM - Afternoon
6-8 PM - Evening
 
Your E-Mail Address:
 
Your Mailing Address
* Address Line 1:
Address Line 2:
* City:
* State:
* Zip Code:
County:
 
Other Information
Current Marital/Partner Status:
Married
Single
Seperated
Divorced
Widowed
Your Spouse's/Partner's First Name (if applicable):
Last Name:
Your Spouse's/Partner's Date of Birth (if applicable):    
* Describe your family make up and interests. Please include any parenting experiences you have and include any special developmental, medical, physical, or emotional childcare skills you may have. Please include how you see this child or sibling group fitting into your family and lifestyle.
You may submit your interest on the children listed above. It will go to the child's adoption director, New York City's Administration for Children's Services, and Heart Gallery NYC.