Application for Adoption


Filing your adoption application online is easy and secure. Simply complete all sections of the form (write "N/A" in boxes that do not apply to your situation). Please have a credit card ready to pay the non-refundable $350 application fee at the end of this form. Once you have submitted this form, you will need to provide the following items to Holt's main office as soon as possible:
  • A signed, notarized copy of Holt's "International Adoption Services Agreement" (IASA) to confirm that you accept the terms of the agreement
  • Photos — The photos may be sent overseas. They need not be professional photos, but must be current and in good quality. Additional photos may be required later by some country programs:
          - Family photo with all family members living in the home
          - The exterior of the home  
  • Taxes — a copy of page one of your last three years' Federal Income Tax Returns (Form 1040 or 1040A)

Please note: If you do not have these documents available in electronic form, you may mail them to our main office with the signed IASA.

Applications are valid for one year from date of receipt.


Last Name
First Name
Middle Name
DOB
Father
Mother
Address  City  County  State  Zip 
Length of time at current residence: (years & months):

Phone Numbers
Home: Preferred No.:
Father Cell: Mother Cell:
        work:           work:
Primary Email: Secondary Email:
Alternative Contact (Identify person/phone):

Current Marriage
Date of Marriage
Previous Marriage(s)
Marriage-Divorce/Annulment Date Marriage-Divorce/Annulment Date Marriage Date-Date of Death
Father
Mother
*If either spouse has more than 2 divorces, contact Holt.

Personal Information
Father Mother
Country of Citizenship
Height/Weight
Education

High School Some College Bachelor's Degree Master's Degree PhD

High School Some College Bachelor's Degree Master's Degree PhD

Religious Preference (optional)
Race/National Origin (optional)

Children (including those from previous marriage)
Name M/F Age DOB Lives at Home *Adopted? Holt? Country
*If you adopted from an agency other than Holt, list agency name, address, & placement date:
     
 
Others Living in Your Home
Name M/F Age DOB Relationship
 
Father's Employment History (last five years)
Employer(s) (list current first) Dates Occupation/Job Title Gross Annual Salary
 
Mother's Employment History (last five years)
Employer(s) (list current first) Dates Occupation/Job Title Gross Annual Salary
 
Financial Information
 
Insurance
Father
Mother
Real EstateValue: $ Mortgages: $ Life Insurance $ $
Saving: $ Other Assets: $ Medical Insurance
Other Income (please specify):
Adopted children covered by insurance at placement?