Electronic Interest Form

If you do not have access to email, please print this form and fax or mail it to:
Indiana Adoption Program, c/o IFCAA
509 E. National Ave., Suite A, Indianapolis, IN 46227
Fax: (317) 524-2609

Call us toll-free 1-888-25-ADOPT [1-888-252-3678] with questions.

Please list the names and ID numbers of the Children in whom you are Interested:

Name:
Race:
Age:
Spouse's name, if applicable:
Spouse' Race:
Spouse' Age:
Email:
Address:
City:	State:
ZIP:	County:
Home Phone Number:
Work Phone Number:

Do you already have an approved Adoptive Homestudy?
Are you in the process of having a Homestudy Completed?
Number of Children currently in your home?
Age of Children?
Desired Age Range of Child?
Desired Sex?
How did you hear about us?
Comments:

*ONLY if you already have an approved Adoptive Homestudy
Please provide the following about the Agency which conducted the Homestudy:

Agency Name:
Case Worker's Name:
Agency Address:
Agency City:	State: ZIP:
Agency Telephone Number:

Electronic Interest Form

*ONLY if you already have an approved Adoptive Homestudy Please provide the following about the Agency which conducted the Homestudy:

Agency Name:

Case Worker's Name:

Agency Address:

Agency City:

State: ZIP:

Agency Telephone Number:

*ONLY if you already have an approved Adoptive Homestudy
Please provide the following about the Agency which conducted the Homestudy: