Adoption Application

Date *

Applicant: FEDEX Account Number: *

We require that you have a Federal Express account. We use the account frequently on your behalf in matters relating only to your adoption. If you do not have an account, visit: www.fedex.com or call 1-800-463-3339.

APPLICANT INFORMATION

Please complete this section with information about the applicant. The spouse section will follow.

Applicant: Last Name *

Applicant: First Name *

Applicant: Middle Name *

Please enter entire legal name, not just first and last name.

Applicant Address *

Enter street address here

Applicant: City *

Applicant: State *

Applicant: Zip *

Home Phone *

Fax Number: *

Applicant: Cell Phone *

Applicant: Work Phone *

Applicant: Email Address *

Applicant: Employer Name *

If unemployed, type "unemployed" here

Applicant: Occupation/Position *

Applicant: Employer Address *

Applicant: Annual Salary *

Applicant: Number of previous marriages *

Date of Current Marriage

Place of Current Marriage

Applicant: Date of Birth *

Applicant: Place of Birth *

Please list city/state

Applicant: Country of Citizenship *

Applicant: Social Security # *

Applicant: Emergency Contact Name: *

Please provide name of emergency contact

Applicant: What is Emergency Contact's relationshp to you? *

(For example, sister, friend, neighbor, co-worker, mother in law)

Applicant: Emergency contact phone: *

Applicant: Passport Status *

I have a current passport (answer passport info below)

My passport is expired (answer passport info below)

I do not have a passport

Applicant: Passport #

If you do not have a passport, enter "No passport" or "Passport Pending"

Applicant: Date Passport Issued

Applicant: Date of Passport Expiration

Applicant: Passport #

If you do not have a passport, enter "No passport" or "Passport Pending"

Spouse Information

Spouse: Last Name

Spouse: First Name

Spouse: Middle Name

Spouse: Cell Phone

Spouse: Work Phone

Spouse: Email Address

Spouse: Employer Name

If not employed, type "not employed" here

Spouse: Occupation

If not employed, type "not employed" here

Spouse: Employer Address

If not employed, type "N/A" here

Spouse: Annual Salary

Spouse: Number of previous marriages

If none, enter 0 (zero)

Spouse: Date of Birth

Spouse: Place of Birth

City/State

Spouse: Country of Citizenship

Spouse: Social Security Number

Spouse: Passport Status

I have a current passport (enter info below)

My passport is expired (enter info below)

I do not have a passport

Spouse: Passport #

Spouse: Date passport issued

Spouse: Date passport expires

Spouse: Place passport issued:

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Kids To Adopt

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APPLICANT INFORMATION

Spouse Information

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