Skip to content
Home
I’m Pregnant
How Can We Help
The Adoption Process
Financial Assistance
Select a Family
FAQ’s
Hopeful Parents
Domestic Program
Inter-Country Program
Home Studies
FAQ’s
Funding & Grant Resources
List of Resources
About
Our Team
Why Choose Premier?
Locations
Blog
Contact
X
View Waiting Families
1-800-876-0187
Adoptive Family Readiness Survey
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Applicant
*
First
Last
Co-Applicant (If applicable)
First
Last
Date of Birth
*
Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
--- Select country ---
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Saint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (Democratic Republic of the)
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Kingdom of)
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland (Republic of)
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (Democratic People's Republic of)
Korea (Republic of)
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia (Republic of)
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine (State of)
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Republic of China
Tajikistan
Tanzania (United Republic of)
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela (Bolivarian Republic of)
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Primary Phone Number
*
Email
*
How did you hear about our agency?
*
What programs are you interested in? Select all that may apply.
*
Domestic
International
Homestudy
Other
Do you have a completed home study
*
Yes
No
In progress
I would like Premier Adoption Agency to conduct one for me. (Only if residing in the states of Utah, Nevada, and Arizona.)
Do you have a profile book complete?
*
Yes
No
In progress
Preferences
Please keep in mind, the more open you are, the more likely you are of being chosen. You are permitted to change your preferences at any point during your adoption journey.
Do you have a preferred gender of the adoptive child?
*
Yes
No
Are you specific about the ethnicity of the adoptive child?
*
Yes
No
How open are you to prenatal alcohol exposure? Please mark all that apply.
*
1st Trimester
2nd Trimester
3rd Trimester
None
Please explain.
How open are you to prenatal drug exposure? Please mark all that apply.
*
1st Trimester
2nd Trimester
3rd Trimester
None
Depends on the type of drug.
Please explain.
*
child? in? have
Are you open to a situation with a history of family mental illness?
*
Yes
No
Depends
Please elaborate.
*
After placement are you open to communicating with the birth family via: Please mark all that apply.
*
Mailed Pictures and Letters Through Agency
Phone Calls/Texts
Social Media
Email
Unsupervised Visits
None
Are you open to paying for birth mother expenses?
*
Yes
No
Unsure
Please provide any additional information that will help us understand your preferences for adoption.
Submit