Home Study Addendum
Agency letter head
HOME STUDY ADDENDUM
NAME:
Date of Birth:
Passport#:
NAME:
Date of Birth:
Passport#:
ADDRESS:
EDUCATION:
MARITAL STATUS:
CHILDREN:
EMPLOYMENT:
PREFERENCE:
SUMMARY OF CONTACTS:
Date : Individual Interview with ______
Date:
Date:
PURPOSE OF THE HOME STUDY ADDENDUM
______and ______completed the home study process through agency name on date initial home study completed. Based on the home study conducted, their financial statements, references from their acquaintances, and their legal considerations, they have been approved to adopt # of children approved for child from Russia. A copy of the original Home Study is attached to this addendum. This addendum is to reiterate this Home Study Agency’s continued recommendation of the ______family for adoption from Russia.
Further, this Home Study Addendum is to serve as notice that their current Notice of Favorable Determination Concerning Application for Advance Processing of Orphan Petition will expire in ______2008. This agency will assume responsibility for completing the home study update as appropriate. This Home Study addendum is submitted with updated Home Study documents: Home Study recommendation letter, Home Study Post Adoption Commitment letter, Agency license, Social Worker’s License and Home Study registration Commitment.
EVALUATION:
Financial Situation:
The financial situation in the last name of the familyhome has not changed since the initial home study was conducted. ______continues to work at place of employment.
Their benefits include full medical and dental coverage, which would cover adopted children from the time that the adoption is finalized. Their total benefits include a life insurance policy of ______which would include adopted children upon placement. The last name of the familyfamily has an auto value asset valued at ______They own their home, which is valued at ______. The family’s assets total______and their liabilities are ______equaling a net worth of ______. According to their financial records, the last name of the family family continue to prove themselves as a financially stable couple capable of living within their means. The median income in the state of ______is ______
Heath and Health Coverage
Mr. ______and Mrs______continue to be physically, mentally and emotionally capable of assuming the responsibilities of adoptive parenthood. Employment letters and financial declaration report from the concerned authorities show that Mr. and Mrs. last name of the family have adequate health coverage to cover their adopted children from the time of placement.
Immigration Pre-Clearance/Legal considerations:
Mr. and Mrs. last name of the familycontinue to state that they have no history of drug or alcohol abuse, sexual abuse, child abuse or domestic violence nor was any discovered by this agency during the process of the initial home study. During the initial home study Mr. ______and Mrs. ______were individually asked if they have ever been arrested for a felony or misdemeanor, whether or not it resulted in conviction. When asked if they have ever been arrested for a felony or misdemeanor, whether or not it resulted in conviction, both answered “no.”
AGENCY RECOMMENDATION
This worker continues to find Mr. and Mrs. last name of the family_to be secure, financially capable, and mentally stable couple. There is no doubt that they possess the ability to be wonderful parents and provide a rewarding environment for an adopted child. Through this evaluation, the previous evaluation, this worker strongly feels that Mr. and Mrs. last name of the family possess the capabilities required to properly parent a child and provide the child, a secure and safe future.
Name of the Home Study Agency, a State licensed child placement agency in the State of ______in the United States of America continue to approve and testify that Mr. and Mrs. last name of the family have met the requirements necessary for adoption in state, in the United States of America. Mr. and Mrs. ______are approved and recommended for the adoption of ______child, either male or female, with none or minor, medical, correctable needs from Russia Our current license is valid through ______
The prospective adoptive parents prefer to adopt # of children child either male or female/ preferably male or female, age ______months or younger with none or minor, medical, correctable needs from Russia.
Respectfully submitted,Reviewed by,
______
Sworn to and subscribed before me this _____day of ______, A.D. 20_____.
Notary Public ______
State of______Countyof______
My commission expires:______