Sharing the Journey Participant Profile

__________________________________________________________________
Name(s)

__________________________________________________________________
Address

______________________
City, State and Zip

___________________________
E-mail Address

______________________
Phone Number

___________________________
Secondary Phone

Preferred Method/s of Contact: _____ Phone _____ Secondary Phone
_____ Email

About Me/Our Family

Please use one form per person, feel free to make additional copies, or contact the ACONE office.

Check all that apply:

__ Adoptee
__ Adoptive family
__ Birth parent/family
__ Foster family
__ Prospective adoptive parent
__ Blended family
__ Single-Parent
__ Gay/Lesbian
__ Transracial
__ Semi-open adoption
__ Open adoption
__ Adoption professional

__ Have adopted child(ren) born in the US
__ Have adopted child(en) internationally
__ Decided against searching
__ Considering searching
__ In process of searching
__ Searched and found
__ Searched but not found
__ Have met birth family
__ Have met my child/ren's adoptive family/ies
__ Living in reunion
__ Other: _______________

Agency used _____________________

If Birth family, role _______________

If Adoptive family, Child/ren profile/s. For each child, please use the same format. Continue on back if necessary (For child/ren born into the family, child/ren will not have placement date or age):

______________
First Name		 ______________
Country/State of origin		 _______________
Birthdate (MM/YYYY)		 ______________
Placement Date		 _____________
Placement Age		 _____________
Special Needs

Please feel free to submit additional information. Use back or additional pages if necessary.