Inquire About an International Adoption Grant with Brittany's Hope

Agency's Full Name*
Contact Name*
First Last
Contact's Title*
Contact's Phone*
Contact Email*
Agency's Website*
Agency's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Executive Director's Name*
Executive Director's Email*
Executive Director's Phone*
Executive Director's Credentials*
Federal ID#*
Your Agency's Federal Classification*
How are you funded? Do you receive any public funding, such as grants?*
Upload your most recent audited financials*
Max. file size: 50 MB.
Upload your Agency's logo*
Max. file size: 50 MB.
List all current affiliations (within the last 5 years)*
in what ways does your organization promote special needs adoptions?*
- Fee Reductions
- Grant Funds
- Loans
- Informational Seminars
- Other
- None
Please explain your agency's interest in becoming a Brittany's Hope affiliate*
Please share your Agency's Mission and/or Vision Statement*
Date Agency was founded*
MM slash DD slash YYYY
Agency founded by?*
Number of Agency's Employees*
Provide us with a brief history of your Agency
Share a recommendation from an affiliate (partner)
Max. file size: 50 MB.
Share a recommendation from an adoptive family
Max. file size: 50 MB.
Are you Hague Accredited?*
Received Hague Accredidation
MM slash DD slash YYYY
Received Hague Accredidation
MM slash DD slash YYYY
Are you COA Accredited?*
Received COA Accreditation
MM slash DD slash YYYY
COA Accreditation Expiration
MM slash DD slash YYYY
In what states can your Agency facilitate International Adoptions?*
Has your license ever been revoked, temporarily suspended, or investigated in any state?*
Please elaborate
Has your Agency ever been the subject of a lawsuit?*
Please elaborate
Please upload a copy of your anti-discrimination policy (religion, orientation,etc) regarding clients*
Max. file size: 50 MB.
Program Information
Approximately, how many international adoptions does your Agency facilitate per year?*
Approximately, how many children with special needs does your Agency place per year?*
Please list all countries where you facilitate adoptions*
What educational tools do you provide to adoptive families considering an older/special needs adoption?*
What post-permanency services do you offer to adoptive families?*
List any Humanitarian Programs your Agency runs in conjunction with your Adoption Program

Program Information