Post Adoption Support Service Request CH/LSS Post Adoption Support Services Step 1 of 5 20% We are committed to providing lifelong, supportive services after an adoption or foster experience.Note: Fees are not due with request submission. Contract or grant funding may apply. We will review your submission and if applicable, provide you an individualized invoice of fees due. On the last part of this request form you will be asked to provide identification. We ask for this in an effort to prevent fraud and protect the information for which we are entrusted.Legal Name(Required) First Middle Last Preferred Name (if different from Legal Name) First Middle Last Your Pronouns (she/her, etc.)Your Date of Birth(Required) MM slash DD slash YYYY PhoneEmail(Required) Street AddressCity(Required)State(Required)Zip CodeIf you live in MN, which county?What is your preferred way to hear from us? Email Phone Mail What is your role in the service you are requesting?(Required) Adoptee Birth/First Parent Birth Family Member Adoptive Parent of Minor(s) Adoptive Parent of Adult(s) Other If other, please describe:Service SelectionPlease select 1 or more service of interest. Note, fees are not due at this time. Contract or grant funding may be available. We will send an invoice if applicable.Search, Reunion & Openness Int'l Search Consultation | $150 Limited Search | $450 Search & Connection: U.S. (Domestic) | $900 Search & Connection: Ethiopia | $1500 Search & Connection: Guatemala | $350 Search & Connection: Romania | $350 Openness Exchange: U.S. (Domestic) | $100 Openness Exchange: Ethiopia Update Delivery | $100 Openness Exchange: Ethiopia Exchange | $300 Documentation, Reports & Citizenship Document Request/File Review | $50 100+ Year Record Request | $100 Certified Court Ordered Record Request | $550 Colombian Birth Certificate Support | $50 Ethiopian Adoption DVD/Lifebook Replacement | $100 Int'l Adoption Finalization & Citizenship Support | $100 Non-Identifying Social Medical History Report | $450 International Adoptee Travel Int'l Search Consultation | $150 Colombia Orphanage Visit | $200 Ethiopia Birth Family Meeting & Travel Support | $1000 Please note a rush fee of $150 applies to requests received within 30-45 days of travel. To assist with locating records, please complete as much information as is known.What Type of Case?(Required) Foster Care (MN) Domestic (U.S.) International If International, which country?What Agency/Organization/County Was Affiliated WIth Your Case?(Required) Children's Home Society of Minnesota (Children's Home) Lutheran Social Service of Minnesota (LSS) Other (ex: Catholic Charities St. Cloud, Hennepin County) If other, please describe:Name(s) of Adoptive Parent(s)Current Name of AdopteeName of Adoptee at BirthBirth Date of Adoptee MM slash DD slash YYYY Name(s) of Birth Parent(s)Birth Date of Birth Parent MM slash DD slash YYYY Please describe your desired outcome of your service (ex: connect to birth parent, retrieve document needed for citizenship, etc.): Support Fund Request (Optional)If service fees are a barrier, you are welcome to apply for a partial or full grant from our Adoption Support Fund. In addition to the information you've provided, please complete the fields below. Applications are reviewed every 2-4 weeks & evaluated based on need. Click "next" to skip.Do you want to request a grant from the CH/LSS Adoption Support Fund? Yes* No *If yes, please complete all the fields below.Your OccupationAnnual IncomeAmount You Plan to ContributeAmount You Are RequestingPlease tell us why a grant would be helpful: Identification VerificationTo prevent fraud & protect the information for which we are entrusted, we ask you to verify your identity by attaching a copy of your photo ID. Upload a copy of your photo ID(Required)Max. file size: 50 MB.Front-side needed onlyAttestation(Required) I attest the information submitted in this Service Request Form is true & correct to the best of my knowledge.PhoneThis field is for validation purposes and should be left unchanged. Δ
