Get California Ad 9 Form

Get California Ad 9 Form

The California Ad 9 form is an Independent Adoption Questionnaire that gathers essential information from prospective adoptive parents. This form is crucial for the adoption process, as it helps the California Department of Social Services assess the suitability of applicants. Completing the Ad 9 form accurately and promptly is vital for a smooth adoption journey.

Start your adoption process today by filling out the form by clicking the button below.

Structure

The California AD 9 form, officially known as the Independent Adoption Questionnaire, serves as a critical tool for prospective adoptive parents. This comprehensive document collects essential information about the petitioners, including personal details such as names, birthdates, and social security numbers. It also delves into the backgrounds of both petitioners, requiring disclosures on education, employment, and military service. The form addresses sensitive topics, such as criminal history, allegations of child neglect or abuse, and domestic violence, ensuring that all relevant factors are considered in the adoption process. Additionally, it requests information about any prior marriages or registered domestic partnerships, as well as details regarding children from those relationships. Family history, including health conditions and educational backgrounds of relatives, is also documented. Completing the AD 9 form accurately and thoroughly is essential, as it plays a significant role in evaluating the suitability of the petitioners for adoption. The California Department of Social Services emphasizes the importance of returning this form promptly, typically within one week, to facilitate a smooth adoption process.

California Ad 9 Preview

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

STATE CASE NUMBER:

INDEPENDENT ADOPTION QUESTIONNAIRE

INFORMATION REQUIRED IN THE MATTER OF THE ADOPTION OF:

FIRST PETITIONER’S NAME:

SECOND PETITIONER’S NAME:

CHILD’S NAME:

CHILD’S ADOPTED NAME:

Dear Petitioner(s):

Complete this Independent Adoption Questionnaire (AD 9) and Adoption Questionnaire I (AD 4324) (to be filled out individually) and return them within one week.

Thank You.

__________________________________________________________________________

(NAME OF CDSS DISTRICT OFFICE OR DELEGATED COUNTY ADOPTION AGENCY)

(Please fill out as completely as possible, writing “NA” or “Unknown” where appropriate)

AD 9 (11/07)

PAGE 1 OF 12

I. FIRST PETITIONER’S INFORMATION

LAST NAME

 

 

 

 

FIRST NAME

 

 

 

MIDDLE NAME

 

 

 

 

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE

 

 

PLACE OF BIRTH

ETHNICITY

 

RACE

 

 

RELIGION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER

 

DRIVER LICENSE NUMBER

EDUCATION

 

OCCUPATION

 

MONTHLY SALARY

 

-

-

 

 

 

 

(HIGHEST GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETED)

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF EMPLOYER

 

LENGTH OF EMPLOYMENT

 

WORK HOURS

 

 

 

WORK TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARE YOU A UNITED STATES CITIZEN?

DATE OF ARRIVAL IN U.S.

 

DATE OF ARRIVAL IN

 

 

 

 

 

YES NO

 

 

 

 

 

 

CALIFORNIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF NATURALIZED

 

 

 

ARE YOU A PERMANENT RESIDENT?

ALIEN REGISTRATION NUMBER

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLACE:

 

 

 

 

YES NO

 

A-

 

 

 

 

 

 

 

NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILITARY SERVICE:

 

 

 

DATE OF SERVICE:

 

DATE OF DISCHARGE:

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

HONORABLE

DISHONORABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A.

CRIMINAL HISTORY

 

 

 

 

 

 

 

1)

Have you ever been arrested for an offense other than a traffic infraction?

 

 

YES

NO

 

If YES, please explain the charges and any convictions:

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

2)

Are you currently on probation or parole?

 

 

 

 

 

YES

NO

 

If YES, please explain the circumstance:

 

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

3)

Have you ever been investigated for allegations of child neglect or abuse?

 

 

YES

NO

 

If YES, please explain the circumstances:

 

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4)

Have you ever been reported for allegations of domestic violence?

 

 

YES

NO

If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

B.FORMER MARRIAGE(S)/REGISTERED DOMESTIC PARTNERSHIP(S) (RDP)

FULL NAME OF FORMER SPOUSE(S)/RDP(S)

(Give maiden name and current address)

WHERE

(License/Registration Issued in County/State)

MARRIAGE/RDP

(Date & Place)

DIVORCE/RDP TERMINATION

(Date & Place)

DEATH

(Date & Place)

AD 9 (11/07)

PAGE 2 OF 12

C.CHILD(REN) BORN PRIOR TO CURRENT MARRIAGE/REGISTERED DOMESTIC PARTNERSHIP

FULL NAME OF CHILD

DATE OF

BIRTH

EDUCATION

(Name & Address of School & Grade)

HEALTH CONDITIONS

IF ADOPTED

(Place, Date, Agency)

1)

Have any of your children ever been arrested for an offense other than a traffic infraction?

YES

NO

 

If YES, please explain the charges and any convictions:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

2)

Are any of your children currently on probation or parole?

YES

NO

 

If YES, please explain the circumstance:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

3)

Have any of your adult children ever been investigated for allegations of child neglect or abuse?

YES

NO

 

If YES, please explain the circumstances:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4)

Have any of your adult children ever been reported for allegations of domestic violence?

YES

NO

If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

 

D.

FAMILY HISTORY

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

 

HEALTH

DATE OF

RELATIVES’ NAMES

ADDRESS

(Highest Grade OCCUPATION

AGE

DEATH

CONDITIONS

 

 

Completed)

 

(If Deceased)

 

 

 

 

FATHER

MOTHER

SIBLING

SIBLING

SIBLING

AD 9 (11/07)

PAGE 3 OF 12

II. SECOND PETITIONER’S INFORMATION

LAST NAME

 

 

 

 

FIRST NAME

 

 

 

MIDDLE NAME

 

 

 

 

GENDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE

 

 

PLACE OF BIRTH

ETHNICITY

 

RACE

 

 

RELIGION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOCIAL SECURITY NUMBER

 

DRIVER LICENSE NUMBER

EDUCATION

 

OCCUPATION

 

MONTHLY SALARY

 

-

-

 

 

 

 

(HIGHEST GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETED)

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME AND ADDRESS OF EMPLOYER

 

LENGTH OF EMPLOYMENT

 

WORK HOURS

 

 

 

WORK TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ARE YOU A UNITED STATES CITIZEN?

DATE OF ARRIVAL IN U.S.

 

DATE OF ARRIVAL IN

 

 

 

 

 

YES NO

 

 

 

 

 

 

CALIFORNIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF NATURALIZED

 

 

 

ARE YOU A PERMANENT RESIDENT?

ALIEN REGISTRATION NUMBER

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLACE:

 

 

 

 

YES NO

 

A-

 

 

 

 

 

 

 

NUMBER:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MILITARY SERVICE:

 

 

 

DATE OF SERVICE:

 

DATE OF DISCHARGE:

 

 

 

 

 

 

 

YES NO

 

 

 

 

 

 

HONORABLE

DISHONORABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A.

CRIMINAL HISTORY

 

 

 

 

 

 

 

1)

Have you ever been arrested for an offense other than a traffic infraction?

 

 

YES

NO

 

If YES, please explain the charges and any convictions:

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

2)

Are you currently on probation or parole?

 

 

 

 

 

YES

NO

 

If YES, please explain the circumstance:

 

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

3)

Have you ever been investigated for allegations of child neglect or abuse?

 

 

YES

NO

 

If YES, please explain the circumstances:

 

 

 

 

 

 

 

 

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4)

Have you ever been reported for allegations of domestic violence?

 

 

YES

NO

If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

B.FORMER MARRIAGE(S)/REGISTERED DOMESTIC PARTNERSHIP(S) (RDP)

FULL NAME OF FORMER SPOUSE/REGISTERED

DOMESTIC PARTNER

(Give maiden name and current address)

WHERE

(License/Registration Issued in

County/State)

MARRIAGE/RDP

(Date & Place)

DIVORCE/RDP TERMINATION

(Date & Place)

DEATH

(Date & Place)

AD 9 (11/07)

PAGE 4 OF 12

C. CHILD(REN) BORN PRIOR TO CURRENT MARRIAGE/REGISTERED DOMESTIC PARTNERSHIP

FULL NAME OF CHILD

DATE OF

BIRTH

EDUCATION

(Name & Address of School & Grade)

HEALTH CONDITIONS

IF ADOPTED

(Place, Date, Agency)

1)

Have any of your children ever been arrested for an offense other than a traffic infraction?

YES

NO

 

If YES, please explain the charges and any convictions:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

2)

Are any of your children currently on probation or parole?

YES

NO

 

If YES, please explain the circumstance:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

3)

Have any of your adult children ever been investigated for allegations of child neglect or abuse?

YES

NO

 

If YES, please explain the circumstances:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4)

Have any of your adult children ever been reported for allegations of domestic violence?

YES

NO

If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

 

D.

FAMILY HISTORY

 

 

 

 

 

 

 

 

 

 

 

EDUCATION

 

HEALTH

DATE OF

RELATIVES’ NAMES

ADDRESS

(Highest Grade OCCUPATION

AGE

DEATH

CONDITIONS

 

 

Completed)

 

(If Deceased)

 

 

 

 

FATHER

MOTHER

SIBLING

SIBLING

SIBLING

AD 9 (11/07)

PAGE 5 OF 12

III. HOUSEHOLD INFORMATION

MAILING ADDRESS

CITY, STATE, ZIP

 

HOW LONG AT PRESENT ADDRESS

 

 

 

I. CELLULAR PHONE NUMBER

II. CELLULAR PHONE NUMBER

HOME TELEPHONE NUMBER

(

)

(

)

 

(

)

 

 

 

 

 

If you are a married or registered domestic couple:

 

If you are an unmarried couple:

 

 

DATE OF MARRIAGE/REGISTRATION:

 

LENGTH OF DOMESTIC PARTNERSHIP/RELATIONSHIP:

 

 

 

 

 

 

 

PLACE OF MARRIAGE/REGISTRATION:

 

HAVE YOU FILED A REGISTRATION OF DOMESTIC PARTNERSHIP WITH THE SECRETARY OF STATE?

 

YES NO

 

 

 

(CITY, COUNTY AND STATE)

 

IF YES, DATE OF FILING:_______________________________________________

 

 

 

 

 

 

 

DESCRIBE YOUR HOME (INCLUDE NUMBER OF BEDROOMS & BATHROOMS):

DIRECTIONS TO YOUR HOME:

HAVE YOU EVER HAD ANY PREVIOUS ADOPTIVE PLACEMENT(S)?

YES

NO IF YES, PLEASE DESCRIBE:

 

 

 

HAVE YOU EVER APPLIED WITH ANOTHER AGENCY?

YES

NO

IF YES, WHEN AND NAME OF AGENCY:

 

 

 

 

 

A.CHILD(REN) OF PETITIONER(S)

FULL NAME OF CHILD

DATE OF

BIRTH

EDUCATION

(Name & Address of School & Grade)

HEALTH CONDITIONS

IF ADOPTED

(Place, Date, Agency)

1)

Have any of your children ever been arrested for an offense other than a traffic infraction?

YES

NO

 

If YES, please explain the charges and any convictions:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

2)

Are any of your children currently on probation or parole?

YES

NO

 

If YES, please explain the circumstance:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

3)

Have any of your adult children ever been investigated for allegations of child neglect or abuse?

YES

NO

 

If YES, please explain the circumstances:

 

 

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

 

______________________________________________________________________________________________________

4)

Have any of your adult children ever been reported for allegations of domestic violence?

YES

NO

If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

AD 9 (10/03)

PAGE 6 OF 12

B.OTHER MEMBERS OF THE HOUSEHOLD

FULL NAME

GENDER DATE OF BIRTH RELATIONSHIP TO FAMILY

OCCUPATION

1)Have any of these members of the household ever been arrested for an offense other than a

traffic infraction?

YES NO

If YES, please explain the charges and any convictions:

 

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

2) Are any of these members of the household currently on probation or parole?

YES NO

If YES, please explain the circumstance:

 

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

3)Have any of these members of the household ever been investigated for allegations of child

neglect or abuse?

YES NO

If YES, please explain the circumstances:

 

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

4) Have any of these members of the household ever been reported for allegations of domestic violence? YES NO If YES, please explain the circumstances and outcome:

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

IV. BIRTHPARENT/LEGAL PARENT INFORMATION

 

BIRTHMOTHER/LEGAL PARENT

 

 

BIRTHFATHER/LEGAL PARENT

NAME (LAST, FIRST, MIDDLE)

 

NAME (LAST, FIRST, MIDDLE)

 

 

 

 

 

MAIDEN NAME OR ALIASES

 

ALIASES

 

 

 

 

 

 

 

ETHNICITY, RACE

BIRTHDATE

ETHNICITY, RACE

 

BIRTHDATE

 

 

 

 

 

ADDRESS

 

ADDRESS

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

TELEPHONE NUMBER

 

 

(

)

 

(

)

 

 

 

 

 

 

 

 

 

A.PLACEMENT DETAILS

DESCRIBE FULLY HOW YOU FIRST LEARNED OF THE CHILD, IF AND WHEN YOU MET THE BIRTHPARENTS/LEGAL PARENT, AND HOW YOU SECURED THIS CHILD FOR ADOPTION. INCLUDE SPECIFIC INFORMATION PERTAINING TO THE TRANSFER OF CUSTODY AND THE NAME OF ANY INTERMEDIARY INVOLVED.

AD 9 (11/07)

PAGE 7 OF 12

B.EXPENSES RELATED TO ADOPTION

HOSPITAL

ADOPTION SERVICE

PROVIDER

PHYSICIAN

ATTORNEY

BIRTHPARENT/ LEGAL PARENT

OTHER

C.CONCERNING CHILD(REN) TO BE ADOPTED

 

 

 

 

CHILD #1

 

 

 

 

 

 

CHILD #2

 

 

NAME OF CHILD

 

 

 

 

 

 

NAME OF CHILD

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BIRTHDATE

 

 

PLACE OF BIRTH

 

 

GENDER

 

DATE PLACED IN HOME

BIRTHDATE

 

 

PLACE OF BIRTH

GENDER

DATE PLACED IN HOME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF HOSPITAL

 

 

 

 

 

 

NAME OF HOSPITAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDRESS OF HOSPITAL

 

 

 

 

 

 

ADDRESS OF HOSPITAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ATTENDING PHYSICIAN

 

 

 

 

 

 

ATTENDING PHYSICIAN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEIGHT

 

 

WEIGHT

 

EYE COLOR

 

HAIR COLOR

HEIGHT

 

WEIGHT

 

EYE COLOR

 

HAIR COLOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HAS THE CHILD EVER BEEN KNOWN BY ANOTHER NAME?

 

 

HAS THE CHILD EVER BEEN KNOWN BY ANOTHER NAME?

 

YES

NO

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT AGE

 

CURRENT WEIGHT

 

 

CURRENT AGE

 

 

CURRENT WEIGHT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO YOU BELIEVE THE CHILD WAS EXPOSED TO ALCOHOL OR DRUGS IN UTERO?

DO YOU BELIEVE THE CHILD WAS EXPOSED TO ALCOHOL OR DRUGS IN UTERO?

YES

NO

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DO YOU BELIEVE OR SUSPECT THE CHILD WAS SUBJECTED TO

 

 

DO YOU BELIEVE OR SUSPECT THE CHILD WAS SUBJECTED TO

 

PHYSICAL, SEXUAL OR EMOTIONAL ABUSE OR NEGLECT PRIOR

 

YES NO

PHYSICAL, SEXUAL OR EMOTIONAL ABUSE OR NEGLECT PRIOR

YES NO

TO PLACEMENT IN YOUR HOME?

 

 

 

 

 

TO PLACEMENT IN YOUR HOME?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IF YES, PLEASE PROVIDE DETAILS:

 

 

 

 

 

 

IF YES, PLEASE PROVIDE DETAILS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BRIEFLY DESCRIBE THE ADJUSTMENT OF YOUR CHILD(REN) TO YOUR HOME:

DESCRIBE CURRENT AND FUTURE PLANNED CHILD CARE ARRANGEMENTS:

DESCRIBE, IF ANY, RELIGIOUS TRAINING PLANS OF THE CHILD(REN):

D.SCHOOL INFORMATION (COMPLETE THIS SECTION IF CHILD(REN) ATTENDS SCHOOL)

NAME OF SCHOOL

 

NAME OF SCHOOL

 

 

 

 

 

SCHOOL ADDRESS

 

SCHOOL ADDRESS

 

 

 

 

 

SCHOOL PHONE

GRADE LEVEL

SCHOOL PHONE

GRADE LEVEL

(

)

 

(

)

 

 

 

 

 

REGISTERED NAME

TEACHER’S NAME

REGISTERED NAME

TEACHER’S NAME

 

 

 

 

 

 

AD 9 (11/07)

PAGE 8 OF 12

V.FINANCIAL INFORMATION

MONTHLY INCOME

 

 

 

 

GROSS WAGES

 

 

 

 

First Petitioner

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ __________________

Second Petitioner

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ __________________

NET WAGES

 

 

 

 

First Petitioner

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

$ ______________________

Second Petitioner

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

$ ______________________

OTHER INCOME (interest, property, dividends, etc.)

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

 

 

 

TOTAL GROSS INCOME

$ ___________________

MONTHLY EXPENSES

 

 

 

 

Housing (include taxes, insurance, & utilities)

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

Insurance

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

Food/Clothing

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

Legal Obligations (child support, alimony, etc.)

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

Extraordinary Expenses

. . . . . . . . . . . . . . . . . . . . . . . . .

. .

. . . . . . . . . . . . . . . . . . . . . . . .

$ ___________________

 

MONTHLY CONSUMER DEBT PAYMENTS

 

 

 

 

 

 

ITEM

TERMINATION DATE

 

BALANCE DUE

MONTHLY PAYMENT

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

 

$

 

$

 

 

 

 

 

 

TOTAL

$

 

$

 

 

 

 

 

 

 

 

 

 

If you own your home, please indicate the following:

Purchase Price

$ ___________________

Balance Due

$ _____________________

FINANCIAL ASSETS

 

 

 

Savings

$ ___________________

Investments

$ _____________________

Stocks, Bonds

$ ___________________

Real Property

$ _____________________

Other Resources

$ ___________________

 

 

If you are self-employed or an employer cannot verify your income for some other reason, please attach a copy of your last year’s federal income tax return.

I/We filed both state and federal income tax returns last year.

YES NO If NO, state reason: __________________________________________________________________________

I/We have had the occasion to file for bankruptcy.

YES NO

If YES, state reason: _________________________________________________________________________

PLEASE USE THIS SPACE TO NOTE ANY ADDITIONAL FINANCIAL INFORMATION THAT YOU BELIEVE THE DEPARTMENT SHOULD BE AWARE OF:

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VI. INSURANCE

Does your family have health and hospitalization insurance that covers all family members? YES NO

If YES, indicate the name of insurance carrier and address:____________________________________________________________

___________________________________________________________________________________________________________

Name and address of family physician:____________________________________________________________________________

___________________________________________________________________________________________________________

Name and address of pediatrician: _______________________________________________________________________________

___________________________________________________________________________________________________________

What provisions for medical care will be provided for the child(ren)?_____________________________________________________

___________________________________________________________________________________________________________

Check the types of insurance coverage your family has and briefly describe each coverage.

Life Insurance: __________________________________________________________________________________________

______________________________________________________________________________________________________

Disability Insurance: ______________________________________________________________________________________

______________________________________________________________________________________________________

Automobile Insurance: ____________________________________________________________________________________

______________________________________________________________________________________________________

Renters/Home Owners Insurance: ___________________________________________________________________________

______________________________________________________________________________________________________

Other Policies: __________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

NOTE: California law (Section 1373(c) of the Health and Safety Code, and Sections 10119, 10112, and 11512.1 of the Insurance Code) requires that effective January 1, 1988, all health care service plans provide accident and sickness coverage to each minor child placed for adoption from and after the moment the child is placed in the physical custody of the covered subscriber or enrollee of adoption.

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Document Data

Fact Name Description
Purpose of Form The California AD 9 form is designed to gather detailed information from prospective adoptive parents as part of the independent adoption process.
Governing Law This form is governed by California Family Code Sections 8600-8618, which outline the requirements for independent adoptions.
Submission Timeline Petitioners must complete and submit the AD 9 form, along with the Adoption Questionnaire I (AD 4324), within one week of receiving the forms.
Information Required The form requires personal details such as names, birth dates, education, occupation, and any criminal history for both petitioners.
Children's Information Petitioners must also provide information about any children born prior to the current marriage or domestic partnership, including their educational and health details.
Confidentiality All information provided in the AD 9 form is confidential and is used solely for the purpose of evaluating the suitability of the petitioners for adoption.

How to Use California Ad 9

After gathering the necessary information, you are ready to fill out the California AD 9 form. This form requires detailed personal information about both petitioners and their family history. Ensure that all fields are completed accurately to avoid delays in the adoption process.

  1. Obtain the California AD 9 form from the California Department of Social Services or your local adoption agency.
  2. Write the state case number at the top of the form.
  3. Enter the names of both petitioners and the child's name in the designated fields.
  4. For the first petitioner, fill out the personal information section, including:
    • Last name, first name, middle name
    • Gender, birthdate, place of birth
    • Ethnicity, race, religion
    • Social Security number, driver's license number
    • Education level, occupation, monthly salary
    • Name and address of employer, length of employment, work hours, and work telephone number
    • Citizenship status and details regarding military service, if applicable
  5. Answer all questions regarding criminal history and family background accurately.
  6. Repeat the process for the second petitioner, providing the same type of information.
  7. List any children born prior to the current marriage or registered domestic partnership, including their names, birth dates, education, and health conditions.
  8. Complete the family history section by providing details about relatives, including names, addresses, occupations, ages, and health conditions.
  9. Review the completed form for accuracy and completeness.
  10. Submit the form to the designated CDSS district office or delegated county adoption agency within one week.

Key Facts about California Ad 9

What is the California AD 9 form?

The California AD 9 form, also known as the Independent Adoption Questionnaire, is a document required by the California Department of Social Services for individuals looking to adopt a child independently. It collects essential information about the petitioners, including personal details, criminal history, and family background. Completing this form is a crucial step in the adoption process.

Who needs to fill out the AD 9 form?

Both petitioners in an adoption must complete the AD 9 form. This includes all individuals who are seeking to adopt a child. Each petitioner must provide their personal information, background details, and any relevant history that could impact the adoption process.

What information is required on the AD 9 form?

The AD 9 form requires a variety of information, including personal details such as names, birthdates, and addresses. It also asks about education, employment, and income. Additionally, the form inquires about criminal history, any prior marriages or domestic partnerships, and information about children from previous relationships. This comprehensive data helps assess the suitability of the petitioners for adoption.

How should the AD 9 form be submitted?

Once completed, the AD 9 form should be returned to the designated California Department of Social Services district office or delegated county adoption agency. It is important to submit the form within one week of receiving it to ensure a smooth continuation of the adoption process.

What happens if there are issues in my background?

If there are any concerns in your background, such as criminal history or allegations of child neglect or abuse, it’s crucial to be transparent on the form. Providing clear explanations can help address potential issues early in the process. The adoption agency will review your background as part of their assessment, and honesty is essential for building trust.

Can I get help with filling out the AD 9 form?

Yes, assistance is available for filling out the AD 9 form. Many adoption agencies offer guidance through the process. You can also consult with legal professionals who specialize in adoption to ensure that all information is accurately provided and to address any questions you may have.

What is the next step after submitting the AD 9 form?

After submitting the AD 9 form, the adoption agency will review your application and may schedule interviews or home visits as part of the evaluation process. They will also require the completion of additional forms, such as the Adoption Questionnaire I (AD 4324). Stay in communication with the agency to understand the next steps and any further documentation needed.

Common mistakes

Filling out the California AD 9 form can be a challenging task. One common mistake people make is not providing complete information. Each section requires specific details about the petitioners and their families. If any fields are left blank, it can delay the adoption process. Always ensure that every question is answered, even if that means writing “NA” or “Unknown” where applicable.

Another frequent error is neglecting to double-check the names and dates. Spelling mistakes or incorrect dates can create confusion. For instance, if a child's name is misspelled or a birthdate is wrong, it may lead to complications later on. Accuracy is crucial, so take a moment to review all entries before submitting the form.

Many people also fail to provide adequate explanations for any “yes” answers in the criminal history section. If there are arrests, probation, or investigations, detailed explanations are necessary. Simply marking “yes” without context can raise red flags. Providing clear and honest explanations helps the reviewing agency understand the circumstances better.

Some petitioners overlook the requirement for both partners to complete their sections individually. Each petitioner must fill out their own AD 9 form. Skipping this step can lead to incomplete applications and further delays. Make sure that both individuals involved in the adoption process take the time to fill out their respective forms thoroughly.

Finally, failing to submit the forms on time is a significant mistake. The instructions clearly state that the AD 9 and the Adoption Questionnaire I (AD 4324) should be returned within one week. Late submissions can hinder the adoption timeline. Set a reminder to ensure that all paperwork is sent promptly.

Documents used along the form

The California Ad 9 form is an essential document in the independent adoption process, serving as a comprehensive questionnaire for prospective adoptive parents. Several other forms and documents are commonly used alongside the Ad 9 to ensure a smooth and legally compliant adoption process. Below is a brief overview of these documents.

  • Adoption Questionnaire I (AD 4324): This form is completed individually by each petitioner and gathers detailed personal information, including background and family history, which is critical for the adoption evaluation.
  • Adoption Agreement: This legal contract outlines the terms of the adoption, including the rights and responsibilities of the adoptive parents and any birth parents involved. It is a crucial document for finalizing the adoption.
  • Home Study Report: Conducted by a licensed social worker, this report assesses the suitability of the adoptive home and family. It includes interviews, home visits, and background checks to ensure a safe environment for the child.
  • Consent to Adoption: This document is signed by the birth parents, giving their legal permission for the adoption to proceed. It is necessary for terminating their parental rights.
  • Notice of Hearing: This form informs all relevant parties about the scheduled court hearing for the adoption. It ensures that everyone involved is aware of the proceedings and can participate as needed.
  • Criminal Background Check Authorization: Prospective adoptive parents must authorize a background check to ensure that they do not have any disqualifying criminal history that could affect the adoption process.
  • Medical History Report: This document provides a comprehensive overview of the medical history of both the adoptive parents and the child. It is essential for understanding any health considerations that may impact the adoption.
  • Post-Adoption Contact Agreement: If applicable, this agreement outlines any ongoing contact or communication arrangements between the adoptive family and the birth family, ensuring clarity and mutual understanding.

These documents collectively contribute to a thorough and transparent adoption process, safeguarding the interests of all parties involved, especially the child. Understanding each form's purpose and requirements can help prospective adoptive parents navigate the complexities of adoption more effectively.

Similar forms

The California AD 9 form serves as an essential document in the adoption process, gathering vital information from prospective adoptive parents. Several other documents share similarities with the AD 9 form, particularly in their purpose and the type of information they collect. Here’s a breakdown of seven such documents:

  • Adoption Questionnaire I (AD 4324): This form complements the AD 9 by gathering individual information from each petitioner. Both forms require detailed personal and family history to assess the suitability of the adoptive parents.
  • California Adoption Application (AD 1): Similar to the AD 9, this application collects comprehensive information about the adoptive parents, including their background and motivations for adoption, ensuring a thorough evaluation process.
  • Home Study Report: Conducted by a licensed social worker, this report assesses the home environment of the prospective adoptive parents. Like the AD 9, it examines family dynamics and the ability to provide a safe and nurturing home for a child.
  • Criminal Background Check Form: This document gathers information regarding any criminal history of the petitioners. The AD 9 also includes sections on criminal history, emphasizing the importance of safety in the adoption process.
  • Medical History Form: This form collects health information about the adoptive parents. Similar to the health-related questions in the AD 9, it ensures that the adoptive parents are physically and mentally prepared for the responsibilities of parenting.
  • Financial Statement Form: This document outlines the financial stability of the adoptive parents. The AD 9 also requests information about monthly salary and employment, which helps assess the financial readiness for adoption.
  • Child Placement Agreement: This agreement outlines the terms of placement for the child being adopted. Like the AD 9, it emphasizes the responsibilities and expectations of the adoptive parents, ensuring that they are fully informed and committed to the adoption process.

Dos and Don'ts

Filling out the California AD 9 form can be a crucial step in the adoption process. To ensure that your application is processed smoothly, here are some important do's and don'ts to keep in mind.

  • Do read the instructions carefully before starting. Understanding what information is required will save you time and reduce the chances of mistakes.
  • Do provide complete and accurate information. Each section is important for your application, so make sure you fill out every field as thoroughly as possible.
  • Don't leave any questions unanswered. If a question does not apply to you, write “NA” or “Unknown” instead of skipping it entirely.
  • Don't rush through the form. Take your time to review your answers before submitting. Errors or omissions can delay the processing of your application.

By following these guidelines, you can enhance the likelihood of a successful submission. Good luck with your adoption journey!

Misconceptions

  • Misconception 1: The AD 9 form is only for married couples.
  • This form is intended for any two individuals looking to adopt, regardless of their marital status. Whether you are married, single, or in a domestic partnership, you can complete the form.

  • Misconception 2: You need to have a perfect background to fill out the form.
  • The form does require you to disclose your criminal history, but having a past does not automatically disqualify you from adopting. Each case is evaluated individually.

  • Misconception 3: Completing the AD 9 form is optional.
  • Filling out the AD 9 form is a required step in the independent adoption process in California. It provides necessary information for your adoption case.

  • Misconception 4: You can submit the form anytime during the adoption process.
  • It is important to return the completed form within one week of receiving it. Timely submission helps keep the adoption process moving smoothly.

  • Misconception 5: The information on the form is not confidential.
  • The information you provide on the AD 9 form is kept confidential and is used solely for the purpose of evaluating your adoption application.

  • Misconception 6: You cannot adopt if you have children from a previous relationship.
  • Having children does not disqualify you from adopting. In fact, the form asks for information about your existing children to understand your family dynamics better.

  • Misconception 7: Only the primary petitioner needs to fill out the form.
  • Both petitioners must complete their sections of the form. Each individual's background and circumstances are important for the adoption evaluation.

  • Misconception 8: The AD 9 form is the only document needed for adoption.
  • The AD 9 is one of several forms required in the adoption process. You will also need to complete the Adoption Questionnaire I (AD 4324) and possibly other documents.

  • Misconception 9: You can leave questions blank if they don't apply to you.
  • If a question does not apply, you should write "NA" or "Unknown" instead of leaving it blank. This helps clarify your situation for the reviewers.

  • Misconception 10: The AD 9 form is only about personal information.
  • The form also includes sections about your criminal history, family background, and any previous marriages or partnerships. This comprehensive approach helps assess your suitability as an adoptive parent.

Key takeaways

  • Understand the Purpose: The California AD 9 form is an Independent Adoption Questionnaire designed to gather essential information about the petitioners seeking to adopt.
  • Complete Information: Fill out the form as completely as possible. If certain information is not applicable, use “NA” or “Unknown” to indicate this.
  • Timely Submission: Submit the completed form along with the Adoption Questionnaire I (AD 4324) within one week of receiving the request.
  • Provide Accurate Details: Ensure that all personal information, such as names, birthdates, and social security numbers, is accurate and current.
  • Criminal History Disclosure: Be prepared to disclose any criminal history, including arrests or investigations related to child neglect or abuse. Transparency is crucial.
  • Former Relationships: Include details about any former marriages or registered domestic partnerships, as this information is relevant to the adoption process.
  • Children's Background: If applicable, provide information about any children from previous relationships, including their educational and health backgrounds.
  • Family History: Include details about immediate family members, such as parents and siblings, focusing on their education, occupation, and health conditions.
  • Review Before Submission: Double-check all entries for accuracy and completeness before submitting the form to avoid delays in the adoption process.