Special Needs (ASAP) Adoption - Pre-Application

Spence-Chapin is currently accepting applications from families who are open to adopting a child with significant medical needs. Families are encouraged to complete our free pre-application below to become registered.  Please send us a copy of your current home study (completed within the past 12 months), conducted by a licensed adoption agency. 

Emailasap@spence-chapin.org

Fax: (888)-742-6126

Mail: Special Needs at Spence-Chapin, 410 East 92nd Street, 3rd Floor, New York, N.Y. 10128


Spence-Chapin promotes equal opportunity for all clients by complying with local, state and federal laws and regulations.  We do not exclude, deny applicants, or otherwise discriminate on the basis of race, ancestry, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, citizenship, military service obligation, veteran status or an other basis protected by federal, state or local laws.  Our policies and practices are intended to ensure that all clients are treated equally.

General Information
Are you applying as a couple or a single applicant?*  
Applicant 1's General Information
Last Name* *
First Name* *
Middle Name
Email
Home Phone
()-ext
Enter Int'l Number
Work Phone*
()-ext
Enter Int'l Number
Applicant 1's Cell Phone
()-ext
Enter Int'l Number
Occupation*
Gender* * 
If "Please Specify", please write gender here:
Date of Birth* *Calendar
Race/Ethnicity  
Home Email*
Applicant 2's General Information
Last Name* *
First Name* *
Middle Name
Email* *
Applicant 2's Cell Phone
()-ext
Enter Int'l Number
Work Phone*
()-ext
*Enter Int'l Number
Occupation* *
Gender* * 
If "Please Specify", please write gender here:
Date of Birth* *Calendar
Race/Ethnicity  
Legal Residence of Applicant(s)
Street Address
Street Address Line 2
City
State/Region
Enter Region
Zip Code
County
Country
Show All Countries
Secondary Address of Applicant(s)
Only enter a secondary (or mailing) address if it is different from the legal residence address.
Street Address
Street Address Line 2
City
State/Region
Enter Region
Zip Code
County
Country
Show All Countries
Marital Status
Marital Status  
Date of Current Marriage Calendar
Home Study Agency
Current Home Study Documents*
Name of Adoption Agency/Attorney
Contact Person
Phone
()-ext
Enter Int'l Number
Date Ended Calendar
Date Home Study was completed.
ASAP Preferences
Preferred Race/Ethnicity
 
Preferred Gender  
Please select the age range(s) of child you envision parenting.
 
Medical Issues
 
Legal Risk Placement  
Openness
 
Specific physical (medical) issues that you are comfortable with and why.
Specific mental/cognitive issues that you are comfortable with and why.
Special Needs Children - Experience
Additional Information
More about your family: anything else you wish to tell us?
How did you hear about us?  
If Other, please explain.
Do you have any specific questions or comments you would like to share?
Other Children in Home
  Family Details | Other Children
 
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