The Adoption Social Work has been communicating with me through email and has scheduled a visit. She asked me to answer a whole bunch of questions and return it via email. Some very personal questions on there, many of the same questions I’d answered for the foster parenting application. Here is the questionnaire in case anyone is interested.
Home Study Questionnaire
Name (Full name), including maiden name, Date of Birth and where you born:
Parents Names, including maiden name, married/divorced/decease (due to what), if they are remarried, please provide that information
Describe your relationship with them.
Siblings? First and last names, age and where they live:
Describe your relationship with them
Where did you grow up (do you still have ties to that community, if so why/how)
Describe your childhood and describe a fond memory from your childhood and a bad memory:
Please describe discipline used by your parents when you misbehaved:
Physical description: height, weight, eye color, hair color:
Date of Marriage and where it took place:
How did you meet your spouse:
Information on your children, name and date of birth:
Is this your first marriage, if not list previous marriages and children that are the result of it:
Include date(s) of marriage, divorce date(s), child(ren) from the union(s), and reason(s) for divorce.
Describe your marriage:
Employment History (Starting from last 20 years until current job, please include years of employment, job title, where, and why no longer employed)
Annual Income –
Car Payment –
Insurance (Auto, home, life) –
Credit Cards/Loans –
Prescription medication –
Recreational activities –
Describe your home: how many bedrooms, bathrooms, dining room, kitchen, laundry room, basement, garage, who rooms in each room with who, etc.. If children share a room do they have their own bed?
Education History (List schools and dates attended) and degrees obtained
Suspensions/expulsions? If so why?
Grades/activities in school and growing up
What branch and dates:
Do you participate in any religious activities, if so what denomination?
Where do you participate in religious activities?
How often do you participate in religious activities?
What made you decide to adopt?
Back-up caregiver: Name/relation, phone, and address
(Is back-up caregiver in agreement with being back-up caregiver?)
How is the back-up caregiver involved with the family?
Physical health conditions? How often do you see the dr for this condition?
Do you take any prescribed medications, if so name, frequency and dosage?
Any substance abuse issues or mental health issues?
What are your hobbies?
How do you think people in the community would describe you? Please describe personal character.
What is your child care plan: (I.e. babysitter, daycare):
What is your response to behavioral issues (Mean of discipline)?
What are your adoptive child’s strengths? What are the hobbies of the child? What do they enjoy doing?
How do you feel about contact with their biological family (parents, siblings and other family?)
Do you understand the child’s background and history?
Do you know the community resources available to you and how to utilize them if needed?
Proposed name of child:
Child’s Dr name and phone number:
Child’s school name, address and phone of school
Teachers name and phone and email
Child’s daycare name and phone number
Teachers at daycare or owner name:
Personal reference name and phone number:
Please feel free to add any additional information that you feel might be important or something that I may have missed.
If there are ANY charges or hits on your background please go into detail about the circumstances of the charges. Please include dates, what happened to the charges (dismissed, fine paid, jail time served). Please be very specific.