Name of husband wife:
Age(date of birth):
Type of home, description of neighbourhood, accessibility to schools, medical facilities, basic amenities in the home and standard of living as evident from the coupleís life style.
Description in terms of physical appearance, complexion, height and build, any characteristic behaviour and general personality.
Family history, including description of family, number of siblings, occupation of parents, economic and social standing. Where born, raised, educated, feelings about early childhood, and family relationships.
Details about educational background, occupation, types of jobs held, current employment status, future plans related to work and career.
Social interests, activities, hobbies, recreational plans.
Adoptive mother (same as above)
Current relationship between husband and wife, the length, quality and stability of marriage, patterns of communication, mutual expectations, value orientations and areas of adjustment. Relationship with members of each otherís families.
Reasons for adoption, feelings about childlessness and inability to have biological children, type of treatment undertaken for infertility, if applicable. Possibility of having biological children in the future, and feelings towards the adopted child. Motivation to adopt in case the couple already has a biological child.
Expectations regarding childís medical and social background, apprehensions regarding hereditary influences, attitude towards illegitimacy, sex, age and religious preferences, if any. Attitudes of significant family members towards adoption.
Anticipated plans after the child comes home. If mother is working, then plans for alternate child care arrangement, etc.
Total family income, stability of source of income, savings, insurance and property.
General health, comment on any illness (current or in the past), present health as stated in the medical report.
The couple has to give letters of reference from persons who can be contacted for further information regarding length of time they have known the couple, their opinion of them as prospective adoptive parents and their recommendations.
Recommendations of the social worker, overall impressions of the couple with reference to special qualities and abilities, capacity for adoptive parenthood, stability of the relationship and overall suitability as adoptive parents.