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Adoption Self-Assessment

1. What age child would you prefer to adopt?

• infant (newborn to 2)
• preschooler (3 to 5)
• primary school (6 to 10)
• middle school (11 to 14)
• high school (15 to 18)

• infant
• toddler
• primary
• middle
• high

• yes
• no

4. Are you willing to adopt a child who has the following disabilities (select as many as apply)?

• emotional mild
• mild emotional moderate
• emotional severe
• mental illness mild
• mental illness moderate
• mental illness severe
• learning disabled mild
• learning disabled moderate
• learning disabled severe
• visually disabled mild
• visually disabled moderate
• visually disabled severe
• hearing disabled mild
• hearing disabled moderate
• hearing disabled severe
• mobility disabled mild
• mobility disabled moderate
• mobility disabled severe
• other disabled mild
• other disabled moderate
• other disabled severe

5. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

6. What racial heritage do you prefer for the child to have? (Note: you may not have a choice. Some state or private agencies will only place children with parents of the same or similar racial heritage.)

• my own heritage
• my partner's heritage
• any / doesn't matter
• other(s) (specify)

7. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

• girl
• boy
• either / hermaphrodite

9. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

10. Are you willing to comply with specific requests of the birth family regarding child rearing (such as religious instruction or schooling)?

• yes
• no

11. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

12. If the home study worker or social worker suggests that you would sooner be approved for a child if you changed your lifestyle in one or more of the following ways, would you be willing to comply (select as many as apply)?

• change residence (larger house, etc.)
• move to other area / city / state
• remove 'inappropriate' pets (pit bull, etc.)
• one partner move out
• apply as single instead of couple
• change or quit job
• other

13. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

14. Do you feel children should be told they are adopted...?

• as early as possible / preschool
• when they ask where babies come from
• mid- to late-childhood
• as adults
• when they ask
• when they find out
• never
• sometime, not sure when
• I don't know if or when

15. If your partner's selection is different are you willing to defer to her/him if it meant you'd get a child sooner?

• yes
• no

16. If your child wanted to find her / his birth family would you be willing to help?

• yes
• no
• don't know

18. What do you feel you could contribute to a child?

19. What aspects of childrearing are so important to you that you would find it difficult to compromise (such as discipline, religion, schooling, stay-at-home parenting, etc.)?

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