Independent Adoption Center

Request Information on Our Open Adoption Program

For Adoptive Parents: Please complete the following form with as much detail as possible (all information is CONFIDENTIAL). IAC's professional counselors will assist and support you throughout your adoption process. An intake counselor will be contacting you once we have received your completed request. IAC is here to help you realize your dream of building a family by bringing a child into your life! Please note: Weekend Intensive Workshops are required for all adoptive parents who want to join IAC. The two-day Workshops are held, monthly, at IAC's regional offices located in Atlanta, GA, Indianapolis, IN, Los Angeles, CA, Pleasant Hill, CA (San Francisco Bay Area), and Raleigh, NC. *Required fields are denoted with a red asterisk.

*Please choose from the following services:
Name(s) (If you are a couple, please include both names)
First: Last:	Phone: ( ) -
	Phone: ( ) -
First: Last:	Phone: ( ) -
	Phone: ( ) -

Mailing Address
*Line 1:
Line 2:
City: State: *ZIP: -

How did you hear about us?
When you started your adoption information search that led you to our website, where did you first find us? (example: Yellow Pages, Friend, etc.) How did you hear about us? To help us be effective in our outreach to you, it would help us if you could identify exactly the path you used to find us. Please type in the field below the Name* of the Search Engine (Google, etc.) or Friend or Attorney, etc. that lead you to us. Please Name: If you found us through a Search Engine, please type in the search word or words you used to find us (or you can add any additional text you feel would be helpful to us): Search Word(s):

*E-mail:

Comments/Suggestions (Optional)


IAC Newsletter Would you like us to e-mail you our quarterly Open Adoption Newsletter each time one becomes available? Yes No