China Self-Report

These Self-Reports, similar to Post Placement Reports, provide overseas officials with confirmation that your child has been placed in a caring and nurturing home. This is compelling information for officials and assists in influencing current processes and policies in international adoption within your child's birth country. We ask that you follow these directions carefully as any information may be requested again if it does not fulfill requirements.

Self-Report Template Instructions and Requirements:

Please provide complete answers to the questions below. Your answers will be formatted into a letter. Please provide at least the minimum number of words required for each section. You will have a chance to elaborate and provide any additional information that you wish for Holt and Chinese officials to know about your child at the end of your report.

Photo Instructions:

  • A minimum of eight photos is required
  • At least half of the photos should include a parent or other family member
  • All photos should show your child’s face (no sunglasses)
  • Please make sure your child is fully clothed in all photos (please no bathtub or swimsuit with no shirt photos)
  • If you are submitting multiple reports for adopted siblings, eight separate photos of each child are required, they cannot be combined

Before clicking the upload button, please include all eight required photos. You can add all of the photos in one upload with corresponding captions.

If you have any questions concerning the information or photos to provide, please do not hesitate to contact us at chinappr@holtinternational.org or call Shirley Baszler, post placement coordinator for the China team, at 541-505-5521 ext. 121.

Identifying parent info, address, email, etc. will be removed from printed report. The form will auto-save form fields except for photos.

Did you receive a Special Needs Adoption Fund grant?

Adoptive Parent's Information:

Adopted Child's Information:

      
           
      

Body of Report:

Please use complete sentences to provide the information requested below. Your responses will be formatted into a letter.

ATTACHMENT AND BONDING:

  • Please describe the relationship your child has with each member of your family.
  • Include information about their attachment with each immediate family member and relevant extended family members.
  • Provide information about improvement or progress made in relationships and attachment.


MEDICAL AND PHYSICAL DEVELOPMENT:

  • Please state your child’s original diagnosis in China, treatments and progress made since the last report.
  • Please include information about any illnesses your child has had in the last year.
  • Provide height, weight and head circumference as well as whether or not their vaccinations are up to date.
  • Describe your child’s gross motor skills and physical abilities.


OVERALL DEVELOPMENT AND EDUCATION:

  • Please include detailed information regarding your child’s language, personality, behavior and social skills.
  • Describe your child’s educational environment, grade level and academic progress, including their attitude toward school and learning.
  • Describe any changes since the last report.

DAILY ROUTINE:

  • Please describe your child’s average daily schedule, including sleeping, meal times, school time, play time and activities.
  • Explain how weekends may differ from weekdays.
  • Describe what your child typically eats, likes and dislikes as well as any concerns you may have.


FAMILY AND COMMUNITY OPINION:

  • Please explain the reactions and opinions of each family member, including the extended family, regarding the adoption of your child.
  • Please describe activities or organizations that you participate in with your child, particularly ones that help your child learn about their Chinese culture.
  • Please state how supportive and accepting your community has been and whether you have resources available to you to meet your child’s needs.


SIGNIFICANT CHANGES:

  • Describe any major changes in the family, such as marital status, children in the home, economic status, employment, residence, serious health problems, etc. (Note: it is OK to include negative changes. China just wants to know that your child is in a loving and stable home, even if challenges exist.)


PLEASE SHARE ANY ADDITIONAL INFORMATION ABOUT YOUR CHILD:

To follow the report:

I hereby swear, affirm and declare, I am the adoptive Father / Mother of the adoptive child (name listed above). I am submitting the year Self-Report, on behalf of myself and my child. All information in this Self-Report is true and accurate and authored by me. Pursuant to Rule 1(E) of the Oregon Rules of Civil Procedure, and Chapter 28 of the United States Code § 1746 : I hereby Swear, Affirm and Declare that the above statement is true to the best of my knowledge.

      

If your child is over 10 years old, please allow them to sign digitally as well, below.

      

Please submit 8 photos of your child and family:

Size of each photo less than 5MB




May Holt also use these materials in the following manners
?

Yes, I give Holt permission to use photos in all manner of media, including unrestricted use for purposes of education, publicity, advertising, trade, display, editorial, exhibits, fund raising, Holt Calendar and art. By clicking "Yes" you also give Holt permission to publish a Welcome Home banner (described below) with your child's photo and first name.

Yes, I give Holt permission to use photos in a Welcome Home banner. Holt International's website features photos of children recently home with a message that says "Welcome Home" and the child's first name.

No

I grant my permission for CCCWA to use my photos for promotion in China:   Yes      No

Holt International is a registered 501(c)3 nonprofit organization. All donations are tax deductible to the full extent of the law. EIN: 23-7257390.