OKDHS - Adoption Interest Form

ADOPT A CHILD - SHARE A HOME

We appreciate your interest. The information will be reviewed by OKDHS. You will be sent an information packet at the mailing address provided.

Fill out the form and select the "Submit Information" button at the bottom of this page.

Required fields are marked with an asterisk * (Use the TAB key to move to the next question.)

Your information

First name*

Middle name

Last name*

Your age

Marital status

Spouse's information

First name

Middle name

Last name

Spouse's age

Home address

Children at home

Address*

City*

County (if in Oklahoma only)

State*

Zip code* (99999-9999)

Mailing address (if different from home address)

Address

City

State

Zip code (99999-9999)

E-mail address

Contact Phone Numbers *

Please provide all that apply, but at least one phone number must be provided.

Home phone (999-999-9999)

Work phone (999-999-9999)

Cellular phone (999-999-9999)

What has prompted your interest? * Your comments or other information:

Yes, I would like to receive electronic information on Adoption.

If you have any further questions about the inquiry process or need to make a correction to the submitted inquiry form, please contact Leslie Knight at leslie.ctr.knight@okdhs.org or Ronda Priest at ronda.ctr.priest@okdhs.org

OKDHS ISSUED 11-5-2006

04AN027W