Caseworker Name
Phone number
Ext.
Cell phone
Email address
Agency name
Child’s name
First
Adopt US Number
Best time(s) and day(s) for scheduling
portrait
If child has siblings, please list all
names and ages
Date of Birth
mm/dd/year
Gender
How long has the child been in care?
Child’s favorite past time activities
(please be specific)
Favorite food?
Favorite sport?
What grade are they in?
How are they doing in school?
What does the child want to do when he/she grows up?
How does he/she intend to accomplish this?
What does the child excel in? (school
subjects, math, science, sports, gardening, etc.)
Child’s personal characteristics (sweet,
shy, intelligent, social, etc.)
Other things that make this child special
What type of family would the child like to be a part
of?
Does the child have special needs? If
so, please list.
What role, if any, do the current foster
parents want to play in this child’s future?
Child needs to be included/listed: (Please
check all that apply)
Other
Has this child ever been involved with the media?
If siblings, should they be recruited for (photographed/interviewed) together?
AES Number
CAP Number
