Preliminary Application Congrats on taking the first step in your adoption journey! Thanks, now we just need a little information… Parent 1 (Mother) * First Name Last Name Parent 1 Birth Date (Mother) * MM DD YYYY Parent 2 (If Single, leave blank) First Name Last Name Parent 2 Birth Date MM DD YYYY Years Married Single Divorced 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30+ Phone * (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Total Yearly Income (format example: $95,000) * # of Children in Home none 1 2 3 4 5 6 7 8 9 10+ If you have children, how old is the youngest child? * Under 5 5 6 7 8 9 10+ Has either applicant been arrested? * Yes No Does either applicant have a current and/or past medical or mental health diagnosis? * Yes No Are you open to adopting a child with special needs? * Yes No Let's Discuss Are you open to adopting a child age 6+? * Yes No Let's Discuss Do you have a region of interest? (check all that apply) Latin America/Caribbean Africa Europe Asia How did you hear about AGCI Web/Google Search Social Media Word of Mouth AGCI Adoptive Family Adoption Forum Other Are there any comments or notes you'd like us to consider? Your preapplication is currently being reviewed. A member of our adoption team will be in touch soon with more information! Thank you for the opportunity to serve you! Join the TDC. Sign Up. Get Empowered. Stay Inspired. Pray Hard. Unlock Possibilities. First Name Last Name Email * Thank you for becoming an official member of the Trauma Disruptor Coalition (TDC). We're so glad you're here!