Foster Care and Adoption Application

Please write "NA" in blocks that don't apply to you.

Applicant 1
Last Name First Name Middle Name DOB Gender
Legal Name
Preferred Name  
Preferred Names Used  
Length of time at current residence: (years & months):
Language(s) spoken in home:

Applicant 2
Last Name First Name Middle Name DOB Gender
Legal Name
Preferred Name  
Preferred Names Used  
Length of time at current residence: (years & months):
Language(s) spoken in home:

Address
Street  City  County  State  Zip 
 
Holt is recruiting foster care & adoptive families ONLY from these counties: (OR) Clackamas, Hood River, Marion, Multnomah, Washington & Yamhill. (WA) King, Pierce & Snohomish.
Type of home: Home ownership:
Total number of bedrooms: Total number of bathrooms:
Areas of water on property: If you have areas of water on property, are they covered or fenced?
Name and breed of pet 1: Name and breed of pet 2:
For more than 2 pets, please list names and breeds:

Contact Information
Home: Preferred No.:
Applicant 1 Cell: Applicant 2 Cell:
        Work:           Work:
Applicant 1 Email: Applicant 2 Email:
Alternative Contact (Identify person/phone):

Current Marital Status           Duration of relationship:
Previous Marital Status Previous status End date of previous status
Applicant 1
Applicant 2
*If either spouse has more than 2 divorces, contact Holt.

Personal Information Applicant 1 Applicant 2
Country of Citizenship
Education

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

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

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

Children (including those from previous relationship(s))
First Name Last Name M/F DOB Lives at Home Relationship Country/State of origin
*If you adopted from an agency other than Holt, list agency name, address and placement date:
     
Further explanation of any above living relationship or living arrangements:
 
 
Others Living in Your Home
Name M/F Age DOB Relationship
Further explanation of any above living relationship or living arrangements:
 
 
 
 

Support

Media

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.