Reference form for prospective adoptive/foster family

Name of Reference (your name)

Name of prospective adoptive/foster family (name of family requesting this reference)

In Which State does the Adoptive/Foster Family Live?

How long have you known the applicant?

In what capacity do you know the applicants?

How frequent is your contact with the applicants?

Have any of the behaviors or conditions below been a problem for the husband?

Have any of the behaviors or conditions below been a problem for the wife?

If you checked any of the problem behaviors above, please elaborate on the nature of the problem.

Please describe the couple's marriage

Please describe the husband's personality:

Please describe how the husband relates to children:

Please describe the husband's feelings toward adoption:

Please describe the wife's personality:

Please describe how the wife relates to children:

Please describe the wife's feelings toward adoption:

Please give us a general statement about the couple's ability to adopt.

Date

Please include your Address

Street Address City State / Province / Region ZIP / Postal Code

Please include your Phone number