Adoption Agency Research Questionnaire

Agency Name: __________________________________ Date Contacted: __________________

Name/Title of the Person Spoken to: _____________________________________________________ Phone: _________________________ Ext. _________ E-Mail: __________________________________ How long has the agency been in business? ______________________________________________ How many adoptions has this agency facilitated? ________________________________________ How long (or how many adoptions) has the agency been facilitating adoptions in the country of interest to you? _______________________________________________________________ What state does this agency operate out of? ______________________________________________  Is this the same state in which the agency is licensed to perform adoptions and where the agency is incorporated (or where they are registered as a non-profit organization)? YES   NO

If yes, what is their license number? _______________________________________________ If no, record information about their license and business incorporation or non-profit status here:

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________    Who is the owner of the business? _________________________________________________ Who is the Executive Director? _____________________________________________________ Has the owner or Executive Director ever owned or operated an adoption agency in another state? YES NO

© 2008 Dawn De Lorenzo

If yes, in what state and what was the name of the agency and the reason the agency is no longer in business? __________________________________________________________

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________  Has the owner or Executive Director ever had their adoption agency license revoked or requested to be surrendered? YES  NO

For domestic adoption: What support services (legal advice, counseling) is offered to the natural mother and natural father before, during, and after placing their child for adoption?

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________  For International Adoption: Does the agency have Hague Accreditation, and if so, what type? ________ ________ ________ ________ Accredited Temporary Accreditation (1 yr.) Temporary Accreditation (2 yr.) Approved For Profit Service Provider YES NO

Is the agency a member any professional organizations?

____________________________________________________________________________________ ____________________________________________________________________________________

© 2008 Dawn De Lorenzo

What support or educational opportunities are available for Adoptive Parents using this agency?

________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________  Does the agency charge a different fee based on race, ethnicity, or gender? YES  NO

Does the agency offer grants for adopting a child with special needs? YES NO

What post-placement support is available? ______________________________________

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________  Have any adoptions facilitated through this agency been disrupted? YES  NO How many? _________________

Does the agency assist adoptive parents facing a disruption of a child adopted through their agency? YES NO

If yes, in what manner is the family assisted? ______________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________________________________________________________  Is the agency fiscally sound? You can check many non-profit organizations’ financial records at www.guidestar.com. Request the agency’s financial records directly. Are they willing to disclose this information? YES NO © 2008 Dawn De Lorenzo

Information Obtained Through My State Licensing Department Contact Name: ______________________________________ Phone/Ext. _________________________________________ Have there been any complaints filed? YES Date: __________________ Title: __________________ NO

If yes, note the date(s), nature of the complaint, whether it was investigated, and the outcome: ________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Client References I urge you to get a minimum of five client references from the adoption agency you are investigating. Ask for references that are recent, as an agency that once enjoyed a positive reputation can quickly become one with numerous complaints. Request references from clients in the program you are interested in as well as others. You want assurances that the agency, in its entirety, conducts itself in a transparent and ethical manor that is respectful of all members of the adoption triad. Reference #1 Name: ________________________________ Phone: ___________________ Year Adopted: _________ Reference #2 Name: ________________________________ Phone: ___________________ Year Adopted: _________ Reference #3 Name: ________________________________ Phone: ___________________ Year Adopted: _________ Reference #4 Name: ________________________________ Phone: ___________________ Year Adopted: _________ Reference #5 Name: ________________________________ Phone: ___________________ Year Adopted: _________ © 2008 Dawn De Lorenzo

WARNING SIGNS
 Is not forthcoming with information.  Does not provide concrete information, but rather speaks in generalizations often emphasizing a “special” or “privileged” relationship that enables the agency to process adoptions faster or assures “healthier” children.  Offering the referral of a child in a country that does not allow pre-identification of a child. Will stress an “ends justify the means” mentality.  Pressure to “sign up” quickly in order to “get a child”.  Attempts to isolate you from the adoption community; urging you to stay off Yahoo groups, blogs, or listservs.  Has a contract with a gag clause.  If you inquire about an issue or negative experience or report from another client be leery if the agency speaks poorly about the client, sometimes going as far as saying “They are crazy/ unrealistic/demanding/too sensitive, etc…”  Operating their business in a state other than where they are licensed especially if the only business address is a purchased “suite box” such as Mail Boxes Etc.  Requests money to be wired to unknown individuals.  Consistently uses language that is emotionally charged often calling into question “how much you really want a child.”  Heated debates on the internet in Yahoo groups and other arenas both in support of the agency and against the agency. There should not be an extreme polarity in opinions. Agencies should not pit clients against each other! *REMEMBER: Choose an agency based on its reputation as a service provider NOT based on a specific child you see in a photolisting. If any agency tries to make you feel “indebted” to them for “getting a child for you” they are being manipulative! © 2008 Dawn De Lorenzo

Important Links and Resources
U.S. Department of State: http://www.travel.state.gov/family/adoption/adoption_485.html Rip Off Report: http://www.ripoffreport.com Adoption Agency Research Group: http://groups.yahoo.com/group/AARD/ Ethica ~ A Voice for Ethical Adoption Placement: www.ethicanet.org/ PACT ~ An Adoption Alliance http://www.pactadopt.org/ Focus on Adoption: An Intercountry Adoption Advocacy Organization http://www.focusonadoption.com/ PEAR ~ Parents for Ethical Adoption Reform http://www.pear-now.org Informed Adoption Advocates http://www.informedadoptions.com Full Contact List for the Attorneys General http://www.naag.org/ag/full_ag_table.php Smart Money Magazine Article: Ten Things Your Adoption Agency Won’t Tell You http://www.smartmoney.com/tb/Jtyq.2FdE.3D

© 2008 Dawn De Lorenzo

US State Licensing Specialists
Alabama Department of Human Resources Faye Wilson 50 North Ripley Street Montgomery, AL 36130 Phone: (334) 242-9500 Fax: (334) 242-0939 E-mail: fwilson@dhr.state.al.us URL: http://www.dhr.state.al.us Alaska Department of Health and Social Services Tracy Spartz-Campbell PO Box 110630 130 Seward Street, Room 4F Juneau, AK 99811-0630 Phone: (907) 465-3209 Fax: (907) 465-3397 E-mail: Tracy_SpartzCampbell@health.state.ak.us URL: http://www.hss.state.ak.us/ocs/ Arizona Department of Economic Security Sybil Oliver Office of Licensing Certification & Regulation - Child Welfare Licensing Unit 1951 West Camelback Road -- Suite 400 Phoenix, AZ 85015 Phone: (602) 347-6340 Fax: (602) 336-9603 Toll-Free: (888) 229-1814 E-mail: soliver@azdes.gov Arkansas Department of Health and Human Services -- Division of Child and Family Services Debbie Roark Child Welfare Agency Licensing Unit PO Box 1437, Slot 570 Little Rock, AR 72203-1437 Phone: (501) 683-2045 E-mail: Debbie.Roark@arkansas.gov California Department of Social Services Community Care Licensing 744 P Street, MS 17-17 Sacramento, CA 95814 Phone: (916) 657-2346 Fax: (916) 657-3783 URL: http://ccld.ca.gov/default.htm Colorado Department of Social Services Marlene Romero Division of Child Care 1575 Sherman Street Denver, CO 80203 Phone: (303) 866-5958 Fax: (303) 866-4453 Toll-Free: (800) 799-5876 E-mail: marlene.romero@state.co.us URL: http://www.cdhs.state.co.us/childcare/ Connecticut Department of Children and Families Thomas Dematteo 505 Hudson Street Hartford, CT 06106 Phone: (860) 550-6306 Fax: (860) 566-6726 E-mail: thomas.dematteo@state.ct.us Delaware Department of Services for Children, Youth and Their Families Cynthia Brown Office of Child Care Licensing 1825 Faulkland Road -- Delaware Youth and Family Center Wilmington, DE 19805 Phone: (302) 892-5800 Fax: (302) 633-5112 E-mail: Cynthia.Brown@state.de.us URL: http://www.state.de.us/kids/occl.htm Delaware Department of Services for Children, Youth and Their Families Maxine Travis Office of Child Care Licensing Barrett Building - 821 Silver Lake Blvd, Suite 103 Dover, DE 19904 Phone: (302) 739-5487 Fax: (302) 739-6589 Toll-Free: (800) 822-2236 E-mail: Maxine.Travis@state.de.us URL: http://www.state.de.us/kids/occl.htm District of Columbia Department of Health Licensing and Regulatory Administration Patricia VanBuren Human Social Services Facility Division 825 North Capital Street NE Washington, DC 20002 Phone: (202) 442-5929 Fax: (202) 442-9430 E-mail: patricia.vanburen@dc.gov Florida Department of Children and Families Chris Lolley Office of Family Safety 1317 Winewood Boulevard -- Building 6 Tallahassee, FL 32399-0700 Phone: (850) 921-1928 E-mail: Chris_Lolley@dcf.state.fl.us Georgia Department of Human Resources Carol Winstead Office of Regulatory Services Two Peachtree Street NW Atlanta, GA 30303-3142 Phone: (404) 657-9611 Fax: (404) 657-5708 E-mail: cswinstead@dhr.state.ga.us URL: http://www.ors.dhr.state.ga.us/

© 2008 Dawn De Lorenzo

Hawaii Department of Human Services Lynn Kazama 810 Richards Street Suite 400 Honolulu, HI 96813 Phone: (808) 586-5698 Fax: (808) 586-4806 E-mail: lkazama@dhs.hawaii.gov URL: http://www.hawaii.gov/dhs/ Idaho Department of Health and Welfare Steve Green Division of Family and Community Services 450 West State Street -- PO Box 83720 Boise, ID 83720-0036 Phone: (208) 334-5534 Fax: (208) 334-6699 E-mail: greens@idhw.state.id.us Illinois Department of Children and Family Services Denise Murray Division of Foster Care and Permanency Services 406 East Monroe Street Springfield, IL 62701-1498 Phone: (217) 785-2688 URL: http://www.state.il.us/dcfs Indiana Department of Child Services Beverly Gatling 402 West Washington Street Room W-364 Indianapolis, IN 46204-2739 Phone: (317) 232-3476 Fax: (317) 232-4436 E-mail: Beverly.Gatling@dcs.in.gov URL: http://www.state.in.us/dcs/protection/lcpa.html Iowa Department of Human Services LaVerne Armstrong Adult, Children, and Family Services Hoover State Office Building, 5th Floor Des Moines, IA 50319 Phone: (515) 281-6802 Fax: (515) 281-4597 E-mail: larmstr@dhs.state.ia.us URL: http://www.dhs.state.ia.us/dhs2005/dhs_hom epage/children_family/adoption/index.html Kansas Department of Health and Environment Linda Sturgeon, MSW, LBSW Child Care Licensing & Regulation, Child Placing Agency and Residential Programs 1000 SW Jackson, Suite 200 -- Curtis State Office Building Topeka, KS 66612-1274 Phone: (785) 296-8892 Fax: (785) 296-7025 E-mail: lsturgeo@kdhe.state.ks.us

Kentucky Cabinet for Health and Family Services Division of Regulated Child Care 275 East Main Street ? 6E-B Frankfort, KY 00004-0601 Phone: (502) 564-7962 Fax: (502) 564-9350 E-mail: rob.hester@ky.gov URL: http://chfs.ky.gov/oig/drcc.htm Louisiana Department of Social Services Bureau of Licensing PO Box 3078 Baton Rouge, LA 70821-3078 Phone: (225) 922-0015 Fax: (225) 922-0014 E-mail: ystewart@dss.state.la.us URL: http://www.dss.state.la.us/departments/os/Li censing_.html Maine Department of Health and Human Services Linda Brissette Office of Child and Family Services 221 State Street -- Station 11 Augusta, ME 04333-0011 Phone: (207) 287-5060 Phone: (207) 287-4139 Fax: (207) 287-5282 E-mail: Linda.Brissette@maine.gov URL: http://www.afamilyforme.org/foster.html Maryland Department of Human Resources Social Services Administration 311 West Saratoga Street Baltimore, MD 21201 Phone: (410) 767-7359 E-mail: emooney@dhr.state.md.us Massachusetts Department of Early Education and Care Central Office 600 Washington Street, Suite 6100 Boston, MA 02211 Phone: (617) 988-6600 E-mail: David.Mcgrath@state.ma.us URL: http://www.eec.state.ma.us Michigan Department of Human Services James B. Gale Office of Child and Adult Licensing 7109 West Saginaw -- PO Box 30650 Lansing, MI 48909 Phone: (517) 335-6124 Fax: (517) 335-6121 E-mail: jbgale@michigan.gov URL: http://www.cis.state.mi.us/brs_cwl/sr_cwl.asp

© 2008 Dawn De Lorenzo

Minnesota Department of Human Services Division of Licensing Human Services Building 444 Lafayette Road North St. Paul, MN 55155 Phone: (651) 296-3971 Fax: (651) 297-1490 Mississippi Department of Human Services Gloria Shelton Division of Family and Children Services 750 North State Street Jackson, MS 39202 Phone: (601) 359-4599 E-mail: gshelton@mdhs.state.ms.us Mississippi Department of Human Services, Division of Family and Children Services Linda Owens 750 North State Street Jackson, MS 39202 Phone: (601) 359-4656 E-mail: lowens@mdhs.state.ms.us Missouri Dept. of Social Services Residential Programs Unit 1500 Vandiver Drive, Suite 103 Columbia, MO 65203 573-884-4394 Montana Department of Public Health and Human Services Laura Taffs PO Box 8005 Helena, MT 59604-8005 Phone: (406) 444-5919 Fax: (406) 444-5956 E-mail: ltaffs@mt.gov URL: http://www.dphhs.mt.gov/cfsd/adoption/adopt ioninmontana.shtml Nebraska Department of Health and Human Services Mary Dyer PO Box 95044 301 Centennial Mall South -- Child and Family Services Division Lincoln, NE 68509-5044 Phone: (402) 471-9331 Fax: (402) 471-9034 E-mail: mary.dyer@hhss.ne.gov URL: http://www.hhs.state.ne.us/adoption/ Intercountry Program - Agency Able to Place Children with United States Citizens Living Abroad (Intercountry)

Nevada Department of Human Resources Wanda Scott Division of Child and Family Services 4220 South Maryland Parkway -- Building B, Suite 300 Las Vegas, NV 89119 Phone: (702) 486-7633 Fax: (702) 486-7626 E-mail: wlscott@dcfs.state.nv.us URL: http://www.dcfs.state.nv.us/DCFS_Adoption. Htm New Hampshire Department of Health and Human Services Gail DeGoosh Division of Children, Youth and Families 129 Pleasant Street -- Brown Building Concord, NH 03301-6522 Phone: (603) 271-4711 Fax: (603) 271-4729 E-mail: gdegoosh@dhhs.state.nh.us URL: http://www.dhhs.state.nh.us/DHHS/FCADOP TION/default.htm New Jersey Department of Human Services Anna Montes Office of Licensing - Youth and Family Licensing PO Box 707 Trenton, NJ 08625-0707 Phone: (609) 987-1985 E-mail: anna.montes@dcf.state.nj.us URL: http://www.state.nj.us/humanservices/adopti on/resourceframe.html New Mexico Department of Children, Youth and Families PERA Building PO Drawer 5160 Santa Fe, NM 87502-5160 Phone: (505) 476-0343 Fax: (505) 827-8480 E-mail: isabel.garcia@state.nm.us URL: http://www.cyfd.org/ New York State Office of Children and Family Services Carol McCarthy 52 Washington Street Riverview Center, 6th Floor Rensselaer, NY 12144 Phone: (518) 474-9406 Fax: (518) 486-6326 Toll-Free: (800) 345-5437 E-mail: carol.mccarthy@dfa.state.ny.us URL: http://www.ocfs.state.ny.us/adopt/agcymenu. Asp

© 2008 Dawn De Lorenzo

North Carolina Division of Social Services Bob Hensley Division of Social Services, Regulatory and Licensing Services 932 Old US 70 Highway, Building 17 -- Black Mountain Center Black Mountain, NC 28711 Phone: (828) 669-3388 Fax: (828) 669-3365 E-mail: bob.hensley@ncmail.net URL: http://www.dhhs.state.nc.us/dss/licensing/ind ex.htm North Dakota Department of Human Services Julie Hoffman Children and Family Services Division State Capitol, Department 325 Bismarck, ND 58505 Phone: (701) 328-4805 Fax: (701) 328-3538 Toll-Free: (800) 245-3736 E-mail: sohofj@nd.gov URL: http://www.state.nd.us/humanservices/servic es/childfamily/adoption/ Ohio Department of Job and Family Services, Office for Children and Families Amy Eaton 50 West Town Street PO Box 182709 Columbus, OH 43218-2709 Phone: (614) 466-1213 Fax: (614) 466-6185 URL: http://jfs.ohio.gov/oapl/index.htm Oklahoma Department of Human Services Division of Child Care PO Box 25352 2400 North Lincoln Boulevard Oklahoma City, OK 73125 Phone: (405) 522-1511 Toll-Free: (800) 347-2276 E-mail: susan.case@okdhs.org Oregon Department of Human Services Treatment Services and Licensing 500 Summer Street NE, E83 Salem, OR 97301-1066 Phone: (503) 947-5208 Fax: (503) 947-5084 E-mail: kathy.spear@state.or.us URL: http://www.oregon.gov/DHS/children/adoptio n/indadoptions/licensedag.shtml

Pennsylvania Department of Public Welfare Office of Children, Youth and Families PO Box 2675 Harrisburg, PA 17105 Phone: (717) 214-9780 Fax: (717) 346-9663 E-mail: ewhitesell@state.pa.us URL: http://www.dpw.state.pa.us/Child/AdoptionFo sterCare/ Puerto Rico Department of the Families Hon. Angie Varela Llavona P.O. Box 11398 Santurce, PR 00910 Phone: (787) 722-7450 Fax: (787) 723-1223 Rhode Island Department of Children, Youth, and Families Lee Sperduti 101 Friendship Street 4th Floor Providence, RI 02906 Phone: (401) 528-3605 Fax: (401) 528-3650 E-mail: lee.sperduti@dcyf.ri.gov URL: http://www.dcyf.ri.gov/licensing.htm South Carolina Department of Social Services 1535 Confederate Avenue PO Box 1520 Columbia, SC 29202 Phone: (803) 898-7507 E-mail: Lstaudt@Dss.state.sc.us URL: http://www.state.sc.us/dss/adoption/index.ht ml South Dakota Department of Social Services David Hanson Child Protection Services 700 Governor's Drive Pierre, SD 57501-2291 Phone: (605) 773-3227 Fax: (605) 773-6834 E-mail: david.hanson@state.sd.us URL: http://www.state.sd.us/social/cps/services/lic ensing.htm South Dakota Department of Social Services District Office Division of Child Protection Services 811 East 10th Street, Department 10 Sioux Falls, SD 57103-1650 Phone: (605) 367-5600 Fax: (605) 782-3149 E-mail: Ronald.Riedel@state.sd.us URL: http://www.state.sd.us/social/cps/services/lic ensing.htm

© 2008 Dawn De Lorenzo

Tennessee Department of Children's Services Mark Anderson 1272 Foster Avenue Nashville, TN 37210 Phone: (865) 594-2836 E-mail: Mark.Anderson@state.tn.us URL: http://state.tn.us/youth/adoption/2005Adoptio nFeeSchedule.pdf Texas Department of Family and Protective Services Char Bateman PO Box 149030 E-550 Austin, TX 78714-9030 Phone: (512) 438-3269 Fax: (512) 438-3848 E-mail: char.bateman@dfps.state.tx.us URL: http://www.dfps.state.tx.us Utah Department of Human Services Janice P. Knaphus Office of Licensing 120 North 200 West, #303 Salt Lake City, UT 84103 Phone: (801) 538-4242 Fax: (801) 538-4553 E-mail: jknaphus@utah.gov URL: http://www.hslic.utah.gov Vermont Department for Children and Families Lucy Abair 103 South Main Street Waterbury, VT 05671 Phone: (802) 241-2159 E-mail: labair@srs.state.vt.us URL: http://www.projectfamilyvt.org/adoption.html Virgin Islands Department of Human Services, Children, Youth and Families Janet Turnbull-Krigger 1303 Hospital Ground Building A-Knud Hansen Complex St. Thomas, VI 00802 Phone: (340) 774-4393 Phone: (340) 774-7865 Fax: (340) 774-0082 Virginia Department of Social Services Leslie Knachel 7 North 8th Street Richmond, VA 23219-3301 Phone: (804) 726-7137 E-mail: leslie.knachel@dss.virginia.gov URL: http://www.dss.virginia.gov/family/ap/index.html

Washington Department of Social and Health Services Randy Roberts Division of Licensed Resources PO Box 45700 Olympia, WA 98504 Phone: (360) 902-7570 E-mail: Rmra300@dshs.wa.gov West Virginia Department of Health and Human Resources Kathie King Bureau for Children and Families 350 Capitol Street -- Room 691 Charleston, WV 25301 Phone: (304) 558-8839 Fax: (304) 558-4563 E-mail: kking@wvdhhr.org Wisconsin Department of Health and Family Services Mary E. Morse Bureau of Regulation and Licensing 1 West Wilson Street -- PO Box 8916 Madison, WI 53708-8916 Phone: (608) 266-0415 Fax: (608) 267-7252 E-mail: morseme@dhfs.state.wi.us URL: http://www.dhfs.state.wi.us/licensing.htm Wyoming Department of Family Services Rose Fry 851 Werner Court Suite 200 Casper, WY 82601 Phone: (307) 473-3924 Fax: (307) 473-3967 E-mail: Rfry@state.wy.us URL: http://dfsweb.state.wy.us/certlist.htm

© 2008 Dawn De Lorenzo