Birth Father Information

Introduction

How did you hear about our agency?

Name *

First

Last

Birth date *

Phone Number *

May we contact you at this number? *

Which method of contact is best? *

text, email, phone, any

Email *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a state issued license?

Are you a U.S. Citizen? *

Place of Birth? *

What is your race/ethnicity?

Living Arrangements

With whom do you live?

Are they aware you are considering adoption?

Are your friends/family aware you are considering adoption?

If yes, are they supportive?

Education

How many years have you completed of Grade school?

How many years have you completed of High School?

How many years have you completed of College?

Do you have any other education experience?

trade, cosmetic, nursing, ect

Personal Interests

Do you have any hobbies or interests?

Favorite food?

Favorite book or movie?

Do you have a personal motto or saying?

Pre and Post Adoption Contact

Here are some ideas to be thinking about in regards to contact with potential adoptive families. 1.) Pictures and Letters: How often, how many years? Example: -Once a year for 18 years -Once a month for the first year, then one a year for 18 years -At the families discretion -Request that A Giving Tree Adoptions holds letters until you’re ready to have -No Pictures or letter 2.) Direct Contact: When, how often? Example: -Phone calls? Emails? Texts? -Zoom/Skype calls before match -Zoom/Skype calls after placement 3.) Face to Face Meetings: When, where, how often? Example: -Meet with potential adoptive families before match -Meet with the adoptive family after delivery -Meet with the adoptive family after placement -Meet with the adoptive family later in the child’s life

Please keep in mind that you do not have to have all the answers to what level of contact you would prefer. We are here to help guide and support you as you make the best decisions for yourself.

Adoptive Parent Preferences

On a scale of 1 to 10, with 1 being the lowest and 10 being completely sure, How sure are you of completing adoption?

Selected Value: 1

**If you have no preference on the adoptive family, please skip to the next section

Do you have a preferred marital status of the family?

married, single, domestic partnership, ect

Do you have a preferred religion of the family?

Do you have a preferred race of the family

Are you open to a family that has other children?

Do you want to be involved in the selection of the family?

Would you like the family to be present for the birth?

Do you want to meet the family?

During the pregnancy, how much contact would you like with the family?

After the birth, would you like contact with the family?

After placement, how much contact would you like with the family?

Please describe your ideal adoptive family

Background

Were you adopted?

If yes, what information do you know?

Have you ever placed a child for adoption before?

Have you ever been arrested or convicted of a crime?

If yes, please give further information.

Have you ever been convicted of child or animal abuse?

If yes, please give further information.

American Indian Information

Are you a member of a Native American or Alaskan Native Tribe? *

If yes, which?

Are you eligible for membership to a Tribe? *

Are any of your relatives members of a Tribe? *

If you have indicated yes to any of the above, please indicate the location, registration or identification number of the Tribe.