Ukraine Adoptions Sample Annual Report

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(Families are not required to use a specific format, however, forms provided by Consular Offices include the following information.)

ANNUAL REPORT ON THE DEVELOPMENT OF ADOPTED CHILD

1. American Name of Adopted Child:
2. Given Name of Child at Birth:
3. Sex of Child:
4. Child's Date of Birth:
5. Child's Place of Birth:
6. Orphanage:
7. Date of Adoption:
8. Residence of Adoptive Parents:

PHYSICAL DEVELOPMENT

1. Height:
2.Weight:
3. General Health: including physical problems,corrective surgery, or therapies:

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4. General development, skill acquisition,achievements, including motor and language skills:

LEARNING SKILLS AND EMOTIONAL DEVELOPMENT

1. Child's personality and his/her characteristics:

2. Emotional development (including attachment to the adoptive parents, relatives, social skills,communication with friends, school, socialenvironment:

3. Difficulties in communication with the child (andbest ways to solve them):

4. Recommendations, sharing of experience

Date:
Signature of Father:
Signature of Mother:

(A form provided on the Ukraine Embassy's Web site can be found here.)

Page 1: What You Need to Know
Page 2: Sample Annual Report

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