Stepparent Adoption Investigation – Client Intake Form

Thank you for choosing me to assist with your stepparent adoption investigation. The information you provide below will help me prepare for the investigation and identify any information or documentation that may be needed. Please answer the questions as completely as you can. If you are unsure how to answer a question, you may leave it blank and we can discuss it together.

Petitioner / Prospective Adoptive Parent

Full legal name

Date of birth

Phone number

Email address

Home address (Street, City, State, ZIP)

County of residence

How long have you lived at your current address?

Your relationship to the child(ren) being adopted

Stepparent Domestic Partner Other

Criminal History and Background Information

Please answer the following questions regarding your criminal history. Any information disclosed may be discussed further during the stepparent adoption investigation.

Have you ever been arrested, charged with, or convicted of a criminal offense, including a misdemeanor or felony?

Yes No

If yes, please provide the approximate date, location, nature of the offense, and outcome.

Are any criminal charges or court proceedings currently pending against you?

Yes No

If yes, please explain

Are you currently on probation or parole?

Yes No

If yes, please provide details, including the anticipated completion date.

Spouse / Partner

Full legal name

Date of birth

Phone number

Email address

Relationship to the child(ren)

Mother Father Other legal parent

Date of marriage or domestic partnership, if applicable

Adoption / Court Information

Has the adoption petition already been filed?

Yes No

County where the adoption petition was filed

Court case number

Date filed, if known

Are you currently working with an attorney?

Yes No

Attorney name

Law firm

Attorney phone number

Attorney email address

Is the child currently the subject of a guardianship or other court proceeding?

Yes No Unsure

If yes, please briefly identify the type of proceeding and court/case number, if known.

Child Information

Add additional child

Household Information

Please list all individuals currently residing in the home.

Add additional individual in home

Petitioner's Employment Information

Employment information is collected as part of the stepparent adoption investigation and may be used to verify the petitioner's employment.

Current employer

Job title/position

Employer address

Length of employment

Supervisor or Human Resources contact name

Phone number

Email address

References

Please provide contact information for three individuals who are not related to you and who are familiar with you and your family. References may be contacted as part of the stepparent adoption investigation.

Add additional reference

Does anyone participating in the investigation need an interpreter, accessibility accommodation, or other assistance during the interview?

Yes No

If yes, please tell me what would be helpful.

Is there anything else you think would be helpful for me to know before we begin the investigation?

By checking this box, we understand that additional information or documentation may be requested as part of the stepparent adoption investigation and that the information we provide may be included in a report submitted to the court.

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