Title: Ms. Mrs. Mr.
First Name:
Last Name:
Login Name:
Password:
Email Address:
Agency:
Director:
Abbreviation for Agency Name (short, no spaces):
Address:
City:
State:
Zip:
Phone:
Fax:
Type: AGENCY FACILITATOR INDIV
Contact for Adoptive Parents:
Parent Contact Email:
Agency Website:
What countries do you place children from?

Is the agency licensed by its state to do international adoptions?
Yes No

Can you place children with non-US citizens in countries other than the US?
Yes No I don't know

Can you place children with US citizens in countries other than the US?
Yes No I don't know

Do you give your personal assurance that placed children will be removed at least once a month and that your agency will only photolist children who are currently available for adoption?
Yes No