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Sample Wording - Unknown special needs of an unknown child:

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

special needs. Both Bradley and Susan have experience and training working with children having various special

needs. 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.”

NOTE: Remember it is always best to address specific special needs to the most serious degree of disability/health

condition where possible.

10. The home study should include a statement that the home study was prepared and reviewed in light of the Convention

Country requirements. See samples below:

Sample Wording - PAP meets the country requirements:

“Bradley and Susan meet all requirements to adopt a child from Country X. They have been married for over 2 years.

They are both between the ages of 30 and 50. They are both physically and mentally stable. Bradley has reliable

employment and their net worth is at least $80,000. Their annual income is at least $10,000 for each family member

in the home.

Both Bradley and Susan have at least a high school diploma. They have fewer than five children under the age of

18, and the youngest child is at least 1 year old. Neither parent has a significant criminal record. They both have a

history of positive character. The PAP has demonstrated an ability to provide a positive family environment and will

be capable of meeting all of the orphaned child’s needs.

Both Bradley and Susan have a body mass index (BMI) less than 40. They also understand the risks of international

adoption to include the processes, expenses, difficulties, and delays. They have also agreed to any post-placement

visits required by law and their adoption agency.”

Sample Wording - PAP does not meet the country requirements:

“Bradley and Susan have been married for over 2 years. They are both 54 years old. They are both physically and

mentally stable.

Bradley has reliable employment, and their net worth is at least $60,000. Their annual income is at least $10,000 for

each family member in the home. Both Bradley and Susan have at least a high school diploma.

They have fewer than five children under the age of 18, and the youngest child is at least 1 year old. Neither parent

has a significant criminal record. They both have a history of positive character. The PAPs have demonstrated an

ability to provide a positive family environment and will be capable of meeting all of the needs of the child they are

seeking to adopt.

Bradley’s body mass index (BMI) is 42 and Susan’s BMI is less than 40. They also understand the risks of

international adoption to include the processes, expenses, difficulties, and delays. They have also agreed to any post-

placement visits required by law and their adoption agency.”

NOTE: In such cases, the home study preparer’s recommendation should include his or her specific approval of Mr.

and Mrs. Smith for the adoption of a child from Country X in light of the country-specific requirements.

11. The home study should include a summary of the results of child abuse registry checks. Child abuse registry checks

must be completed for the PAP and any additional adult member of the household 18 years of age or older. This

should be completed for all states and countries in which they have resided in since the age of 18, where there are

child abuse registries available.

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 4