Foster Care And Adoption Program Reference

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Loftus-Vergari and Associates, Inc.
Foster Care and Adoption Program
65 North Washington Street
Wilkes-Barre, PA 18701
Phone: (570) 822-9706
Email:
Fax: (570) 824-1408
Name and Address of Reference:
Dear
The
have provided your
name as a character reference that can attest to their suitability as adoptive parents of
.
We would appreciate your response in a timely fashion to the enclosed questionnaire. Please
be as thorough as possible, citing examples of your observations, if appropriate. We can assure
you that any information you provide on this form will be kept in the strictest confidence. You
will not be named as the source of any information which you provide and your confidentiality
will be carefully protected.
Signature of Adoption Worker
1.
How long have you known the applicants?

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