Iowa KidsNet

Request For Information:

You must have an approved homestudy to receive additional information on waiting children.

If you are interested in a specific child or sibling group, please complete the following form. Once this form is submitted, Iowa KidsNet will receive your information via e-mail along with the name of the child you have inquired about. To reduce duplicate requests, we ask that you only submit this form regarding this child or sibling group. You will be contacted by Iowa KidsNet within 2 business days.

How did you learn about Iowa KidsNet?

Name and Address
If you are a couple use both first and/or last names.

First Name:

Last Name:

Address:

City:

State:

Zip:

County:

Phone/E-mail/ Mailing Information

Home Phone:

Work Phone:

Cell Phone:

Best # to call
during business hours:

E-mail Address:

In order to receive a response, an e-mail address must be provided.

Demographics

Marital status:

Are you a foster parent?

Have you adopted before?

Homestudy Information

Have you completed a homestudy?

If yes to Homestudy:

Date study completed:

Agency that completed study:

Worker Name:

Worker Number:

Children in the Household
Please list all children including adopted, foster and birth children.

Age	Gender	Relation	Disability

Adoptive Preferences

Age Preference:

(Enter the oldest age you would consider)

Gender Preference:

Choose the highest level of disability you will consider.

Physical Disabilities:

Learning Disabilities:

Emotional Disabilities:

Mental Disabilities:

Sibling Group:

Please enter the code you see below:

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