Your Current Information

Male Female

        Mobile:

Some High School High School GED Tech./Vocational School Some College Associates Bachelors Masters Doctorate Other

Married   Single    Divorced

Yes    No 

Have you utilized Holt's background information service? (Please check all that apply)

Is searching for your birth family an important issue for you?

Important   Somewhat   Not Important    Not At This Time   Not Sure

Medical   Curiosity   Other

Do your parents know you're searching?  Yes    No

Are they supportive?  Yes    No

Have you searched before?  Yes    No

Did you locate your birth family?  Yes    No

Have you met your birth family?  Yes    No

If yes, do you have an ongoing relationship?  Yes    No

Would you like to be in contact with other adoptees who have searched?  Yes    No

Have you ever traveled to your birth country?  Yes    No

Have you participated in Holt Heritage Camp?  Years:

Years

Years

Do you currently participant in an adoptee group?  Yes    No

I would like to receive Holt's Enewsletter: Yes    No

I would like to be added to Holt's E-mail information update list: Yes    No

I would like to receive a complimentary copy of Holt's Holt International magazine: Yes    No

I would like to attend Adult Adoptee events in my area: Yes    No

I would like information about the Birth Country Tour:  Yes    No

I am interested in Volunteer Opportunities:  Yes    No

Choose Holt Website Holt Enewsletter Internet List Serve Family/Friends Adoptee Group   Other