*
Sign up not allowed by admin.
Please contact admin for registration.
*
SIGN IN
User Name
Password
Lost your password?
International Adoption
China Adoption
Orphan Hosting
Student Exchange
Login
Sign Up
+1 (512) 323-9595
info@childrenofallnations.com
Toggle navigation
Photo Listing
Adoption Programs
Current Programs
Bulgaria
Burundi
China
Dominican Republic
Haiti
Honduras
Latvia
Latvia Hosting
Malawi
Ukraine
Waiting Child
Photolisting
Singles Adoption
Past Programs
Orphan Care
Haiti Orphan Care Trip
Amazon Smile
Cake Packages
China Orphan Care
China Orphan Care Trips
Hosting Volunteer
Past Orphan Care Projects
Services
Home Study Only
Medical Referral Program
Student Exchange
Host Exchange Students
Work with Students
Hague Adoption Training
Re-Adoption
Travel Programs
Heritage Tours
China Homestay
Adoptee Cultural Exchange
About
Our Story
CAN Difference
Hague Convention
Testimonials
FAQs
Financial Assistance
Fundraising
Get Involved
Contact Us
Adoption Blog
Adoption Resources
Events & Webinars
Surveys
Opportunities at CAN
Work with Students
Volunteer with Students
Online Payment/Donation
Apply Now
Eligibility Check
Home
Eligibility Che
Eligibility Check
Please take the time to fill out the eligibility check completely. Our management team and country representatives will review and determine your family's eligibility. Thank you so much, and we will contact you shortly!
Who Referred you to this Eligibility Check?
*
The best phone number to contact your family
*
The best email to contact your family
*
Country of Interest
*
China
Philippines
Burundi
DRC
Ethiopia
Ghana
Uganda
Bulgeria
Latvia
Moldova
Poland
Ukraine
Dominican Republic
Guyana
Haiti
Hondruas
Domestic
Child Parameters
Please check all that apply for your family.
Male
Female
Waiting Child Progam
Healthy Referral Program
Ages 0-3
Ages 3-6
Ages 6-9
Ages 9-12
Ages 12+
Are you Married?
*
Yes
No
What is your gender?
*
Male
Female
Marriage Date
*
Mother's Prior Divorces
*
0
1
2
3
4
Father's Prior Divorces
*
0
1
2
3
4
Mother's Name
*
First
Last
Father's Name
*
First
Last
Mother's Age
*
Father's Age
*
Mother's Ethnicity
*
Father's Ethnicity
*
Number of Children
*
0
1
2
3
4
5
6
7
8
9
10
11+
Please list the ages of the children in the home
*
If a child living in your home has a medical condition, please explain below
Mother's Religion (if applicable)
How long have you practiced in this faith?
Father's Religion (if applicable)
How long have you practiced in this faith?
If you subscribe to a religous belief system, does this prohibit any type of medical treatment for your potential adopted child?
yes
no
Mother's Medical Condition
*
No diagnosis
Diagnosis of medical condition
Please describe prior medical diagnosis.
*
If you have a prior surgery or medical diagnosis, please list the dates. If this is ongoing, please describe how this diagnosis affects your everyday life.
Father's Medical Condition
*
No diagnosis
Diagnosis of medical condition
Please describe prior medical diagnosis.
*
If you have a prior surgery or medical diagnosis, please list the dates. If this is ongoing, please describe how this diagnosis affects your everyday life.
Mother's Mental Health
*
No diagnosis
Mental Health Diagnosis
Please describe prior mental health diagnosis.
*
If you have ever had a mental health diagnosis, please describe what the diagnosis was and include the dates of diagnosis. Please also indicate if you saw a mental health professional during this time.
Father's Mental Health
*
No diagnosis
Mental Health Diagnosis
Please describe prior mental health diagnosis.
*
If you have ever had a mental health diagnosis, please describe what the diagnosis was and include the dates of diagnosis. Please also indicate if you saw a mental health professional during this time.
Mother's Medication Usage
*
No History of Medication Usage
History of Medication Usage
Please describe prior medication usage.
*
If you have ever used prescription medication, please indicate the medication name, dosage, time used, and reason this medication was used.
Father's Medication Usage
*
No History of Medication Usage
History of Medication Usage
Please describe prior medication usage.
*
If you have ever used prescription medication, please indicate the medication name, dosage, time used, and reason this medication was used.
Mother's Criminal History
*
No History of Criminal Charges or Child Abuse/Neglect in the US or Abroad
History of Criminal Charges or Child Abuse/Neglect in the US or Abroad
Please describe charges.
*
If you have ever had allegations, charges, or convictions of any criminal or child abuse, please indicate below. Please include the date, original charge, disposition of the charge, and how the charge was resolved. (Some countries may require that documentation be provided before the eligibility check will be completed)
Father's Criminal History
*
No History of Criminal Charges or Child Abuse/Neglect in the US or Abroad
History of Criminal Charges or Child Abuse/Neglect in the US or Abroad
Please describe charges.
*
If you have ever had allegations, charges, or convictions of any criminal or child abuse, please indicate below. Please include the date, original charge, disposition of the charge, and how the charge was resolved. (Some countries may require that documentation be provided before the eligibility check will be completed)
Combined Annual Income for the prior year
*
Projected Annual Income for this year
*
Family's Assets
*
Please include anything that your family owns that has value (including cars, appliances, jewelry, homes, books, etc.)
Family's Liabilities
*
Please add up the debt that your family has including loans, mortgages, credit card debt, etc.
Family's Total Net Worth
*
Please subtract your liabilities from your assets and put the total amount below.
Additional Information (optional)
Please indicate any additional information that you would like our agency to consider when reviewing your eligibility.
Disclaimer
*
Please be aware that by submitting this Eligibility Check, you are stating that all this information is true to the best of your knowledge. This information will be required to have documented proof in the dossier process. If any of this information is difference than indicated in this form, the country and central authority may reject your application for adoption. Our management team cannot guarantee that your family will be approved for adoption. The country and central authority will approve your application for adoption once the entire dossier is sent to the country and reviewed. This Eligibility Check is meant to determine whether the country will consider your application for adoption. Please sign your name below to indicate that you have read and agree to this disclaimer.