Use this form to request information and/or contact. Please complete at least the first four fields of information - so a representative from Hamilton County will be able to respond to you. Thank You!
First name *
Last name *
Your phone *
e-mail address *
Street address
City
State
Zip
What is your racial background? African American Caucasian Bi-racial Asian/Pacific Islander Native American Other
Do you already have an approved Homestudy?
No Yes
If Yes, please provide the following information:
Agency Name
Agency Street Address
Social Worker's Name
Social Worker/Agency Phone Number
Important:
In the following questions, please check ALL that apply.
Are you interested in:
A girl A boy Siblings
Would you consider a child with:
Physical disabilities Mental Disabilities Emotional Disabilities Learning Disabilities
Degree of physical difficulty you would consider:
Mild Moderate Severe
Degree of mental difficulty you would consider:
Degree of emotional difficulty you would consider:
Which age group would you consider?
0 - 6 years old 7 - 11 years old 12 and older Any age
Which racial background would you consider?
American Indian / Alaskan Native Asian Black / African American Hawaiian / Pacific Islander Hispanic White
Do you have any comments for us?
Note: if you don't receive confirmation of your submittal within 10 days, please call (513) 632-6366.
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