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See sample below:

Sample Wording:

“According to the 1040 Income Tax Form submitted by Bradley and Susan Smith for 2007, their adjusted gross

income was $100,000. They have monthly expenses of $2,400, including a mortgage and debts. This leaves an

abundant monthly income to care for an additional child. The Smiths meet or exceed State X financial guidelines

for adoption. The Smith home is valued at $220,000 with mortgage remaining of $150,000. The family has savings

of $10,000 and an IRA/401K worth $400,000. Bradley has a life insurance policy worth $125,000, and Susan has a

policy worth $100,000.”

7. The home study should address the pre-placement preparation and training that the parents have completed or plan to

complete to prepare for their adopted child’s arrival. This would also include the plans for post-placement monitoring

in the event the adoption will be finalized in the United States rather than in the country of birth.

8. The home study should also include a detailed description of the living accommodations where the PAP(s) currently

reside. If they plan to move, the home study should include a description of the future living accommodations,

if known. Each description should include an assessment of the suitability of the accommodations for a child (or

children) having the characteristics of the child (or children) that the PAP(s) are approved to adopt and a determination

whether such space meets State requirements, if any. See sample below:

Sample Wording:

“Bradley, Susan, Ngoye, and Emma have recently moved into a newly developed residential area that was built within

a top-rated school district. The development has a diverse population, including a family from Country X.

The home consists of 3,500 square feet of living space. The first level of the home contains an open foyer, living

room, formal dining room, office, 1/2 bath, eat-in kitchen, and a family room with a fireplace. The second level of

the home contains a laundry room, master bedroom and bath, three bedrooms, and one shared bathroom. One of the

additional bedrooms belongs to Ngoye and Emma, and one has been decorated as the nursery for their new sister

from Country X. The third bedroom is the guest bedroom. The basement contains a bathroom, movie/game room,

an additional bedroom, and a craft/playroom. The home also has an attached three- car garage and a large fenced-in

backyard.

Each level of the home is fully equipped with smoke alarms, carbon monoxide detectors, and fire extinguishers.

This home also has access to public utilities, shopping, local fire and police departments, medical services, major

roadways, and recreational and cultural activities.

This home exceeds the State X requirements for safe and suitable accommodations for a child.”

9. If the PAP wishes to adopt a child with a disability or special needs, the home study must contain a discussion of the

preparation, willingness, and ability of the applicant to provide proper care for a child with a disability or special

needs. See samples below:

Sample Wording - Known special needs condition of a child:

“Bradley and Susan are seeking to adopt one female child from Country X, age 0-4 years with mild to moderate

special needs. Baby Chen, who was born on June 1, 2007, has the minor special need of congenital heart defect and

ASD, or atrial septal defect. The Smith’s have reviewed the child’s medical records and consulted with medical

professionals, including those who work in the field of intercountry adoption medicine. Having done the research on

this medical condition, they feel well prepared to parent a child with this special need and would like to pursue the

adoption of this child. It is the opinion of this home study preparer that the Smiths have demonstrated the appropriate

preparedness, willingness, and ability to parent a special needs child with the above stated health issues.”

Form M-738 Instructions 07/27/09 N

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Instructions For Form M-738 - Hague Home Study Tip Sheet For Adoption Service Providers And Prospective Adoptive Parents Page 3