Test

Adopting Father’s Full Name*

Adopting Mother’s Full Name*

Home Address (Mailing Address)*

Primary Contact:*

Father

Mother

Single Parent:*

Yes

No

Adopting Father

Phone*

Email*

Untitled*

Date*

Driver’s License No.*

Adopting Father’s Occupation*

Employer*

Employer Address*

Length of Employment*

Monthly Net Salary $*

Previous Employer*

Adopting Mother

Phone*

Email*

Untitled*

Date*

Driver’s License No.*

Adopting Mother's Occupation*

Employer*

Employer Address*

Length of Employment*

Monthly Net Salary $*

Previous Employer*

Years You Have Been Married*

Name and Age of Children in the Home*

Child Name

Child Age

Have you adopted before?*

Yes

No

please provide details*

Adoption Financials

Amount of financial assistance requested, up to $10,000.00 (interest-free loan)*

Would you be able to complete your adoption without assistance from Pathways for Little Feet?*

Yes

No

If approved, what amount could you agree to repay each month until full reimbursement is made?*

(*This is not binding. After review, we may request your consideration of a different monthly payment amount.)

Adoption Costs

Home Study and Related Fees*

Total Agency Fees*

Consultant Fees*

Travel Expenses*

Other:*

Total Anticipated Adoption Costs*

Please upload your current anticipated cost document provided by your attorney, consultant, agency, or other provider.*

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 256 MB.

Source of Funds

Personal Funds (savings, etc.)*

Employer Assistance*

Fundraising*

Grant/Loan*

Grant/Loan:

$

Applied or awarded?

Please list each granting organization individually

Other:*

Total Estimated Resources*

Statement of Net Worth

Assets

Cash*

Checking*

Savings*

Investments:

Stocks*

Bonds*

Real Estate (other than your home)*

Retirement Accounts*

Value of Home (if owned)*

Value of Autos*

Household*

Other:*

Total Assets*

Liabilities

Outstanding Credit Card Balances*

Student Loans*

Home Mortgage Balance*

Auto Loan Balance*

Any Other Bills/Amounts Owed:*

Bills/Amounts Owed

$

Total Liabilities*

Total Net Worth (Assets – Liabilities)*

Cash Flow

Income (Please note net income is after taxes, 401K, healthcare and other witholdings)

Monthly Net Salary/Wage*

Other Monthly Income:*

Total Net Income*

Expenses & Payments

Church/Charitable Giving (Tithe)*

Debt Repayment (not including mortgage)*

Housing:

Mortgage/Rent*

Property Taxes*

Home/Rental Insurance*

Utilities*

Other*

Other

$

Phone/Internet*

Groceries/Food*

Transportation:

Car Payment*

Car Insurance*

Gas/Maintenance*

Other*

Other

$

Entertainment/Recreation*

Medical Expenses*

Child Care*

Other*

Misc./Other

$

Total Expenses*

Cash Flow (Income – Expenses)*

Consent Form

By signing this form and submitting this application:

Please read closely and respond accordingly

We hereby give consent for Pathways for Little Feet to contact our adoption agency and any other person or institution named in this application and we authorize such persons and institutions to release information to Pathways for Little Feet. It is our understanding that information obtained will be used, in part, to determine our eligibility for a loan. We also understand and agree that Pathways for Little Feet is not obligated to provide financial assistance based on the willingness to accept an application.

We understand, if approved for an interest-free loan, that our agreement would be in the form of a covenant with Pathways for Little Feet. This covenant agreement includes the approval of an auto-draft authorization for monthly repayments of the loan, beginning two months after the funds are released to the adoptive parents.

Once the adoption is complete, we give Pathways for Little Feet permission to use our story and/or photographs in their communications and/or marketing material, with the purpose of advocating for adoption and helping more families adopt. We understand that Pathways for Little Feet will protect our family and child's identify by utilizing a false name or letter to represent our story.

If approved for an interest-free loan, we agree to share our adoption story, be interviewed by Pathways for Little Feet, and/or provide pictures and updates with the purpose of advocating for adoption and helping more families adopt.

If approved for an interest-free loan, we agree to share our adoption story, be interviewed by Pathways for Little Feet, and/or provide pictures and updates with the purpose of advocating for adoption and helping more families adopt.*

Yes

No

*If no, please explain*

Signature of Adopting Father*

Print*

Date*

Signature of Adopting Mother*

Print*

Date*

References & Application Checklist

References:

Name*

Phone*

Email*

Relation*

Name*

Phone*

Email*

Relation*

Name*

Phone*

Email*

Relation*

Please upload your 3 personal or character references. These can be references you utilized for your Home Study or Adoption Agency.*

Drop files here or

Max. file size: 256 MB.

How did you hear about Pathways for Little Feet?*

Submitting Application & Checklist:

Please submit the following information for both parents as applicable:

Full Approved Original Home Study & Any Updates*

Drop files here or

Max. file size: 256 MB.

Current Credit Score and Report for Both Parents*

Drop files here or

Max. file size: 256 MB.

Please upload the full credit report that includes your credit score, credit history and has your name on the file

Most Current Year’s Tax Information*

Drop files here or

Max. file size: 256 MB.

Last Month’s Bank Statements (Checking & Savings)*

Drop files here or

Max. file size: 256 MB.

Please include all accounts

Copy of Both Parents Valid Driver’s License*

Drop files here or

Max. file size: 256 MB.

Copy of Last Two Pay Stubs per Individual*

Drop files here or

Max. file size: 256 MB.

Letter of Recommendation from a Pastor at Your Church*

Drop files here or

Max. file size: 256 MB.

This can be your small group leader or pastor at your church who knows your family best

CAPTCHA

Test

Family Fund Interest-free Loan Application

Adopting Father

Adopting Mother

Adoption Journey & Faith Statement

We’d like to get to know your faith background and how the Lord has brought you to adoption!

Statement of Faith:

Adoption Financials

Adoption Costs

Source of Funds

Statement of Net Worth

Assets

Liabilities

Cash Flow

Income (Please note net income is after taxes, 401K, healthcare and other witholdings)

Expenses & Payments

Consent Form

By signing this form and submitting this application:

References & Application Checklist

References:

Submitting Application & Checklist:

Please submit the following information for both parents as applicable:

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Copyright

Peace Cowen

Development Specialist