Report on Outgoing Adoption

The highlighted fields are missing or incorrect.

Please correct the following information:

Child Information

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Place of Birth

Adoptive Parent Information

Parent 1 First Name

Parent 1 Last Name

Parent 2 First Name

Parent 2 Last Name

Address

Phone Number

Adoption Location

U.S. State from which the child is emigrating

U.S. State where the final adoption is taking place OR the U.S. State where legal custody for the purpose of adoption is being granted

The name of the country where the final adoption is taking place

Reporting Provider Information

Name

Address

Phone Number

Fax Number (optional)

Comments/Remarks (optional)

Case and Final Adoption Information (Optional)

As a reporting provider, I understand that I must report any change to the information provided herein and the following milestone case information witin 30 day of occurrence

Date the case is determined to involve emigration from the United States (generally the time the adoptive child is match with adoptive parents)

Date of U.S. final adoption or date on which custody for the purpose of adoption was granted in the United States

Date of foreign final adoption if custody for purpose of adoption was granted in the United States, to the extent practicable

Any additional information

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Intercountry Adoption from A-Z:

The Hague Convention on Intercountry Adoption:

Frequently Asked Questions: