• 1 Family Types you prefer: ( Select All that apply )

  Any Family Type Male + Female Couple Same Sex Female Couple Same Sex Male Couple Single Female

• 2 Age Ranges of Adoptive Parent(s) you prefer:
  ( Please select all that apply )

  20 – 35 35 – 50 51 +

• 3 Prefer Adoptive Parent(s) with children?
  ( Please select all that apply )

  Yes No No Preference

• 4 Religion of Adoptive Parent(s)?
  ( Please select all that apply )

  Any Religion No Religious Affliliation Catholic Jewish Hindu Christian

• 5 What is your race / ethnicity ?
  ( Please select all that apply )

  African American Asian Caucasian East Indian Hispanic Middle Eastern Pacific Islander

• 6 What is the race/ethnicity of the biological father?
  ( Please check all that apply )

  African American Asian Caucasian East Indian Hispanic Middle Eastern Pacific Islander

• 7 What is the gender of your baby?

  Boy Girl Don’t Know Yet

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