reference Letter                                       13

Please send this form to the references listed on your application and have them mail it directly to the address listed below. Your application is not complete until we receive all of your references.

Reference Form

The clients listed below have requested that you be a character reference for them for their adoption application. Please fill this form out completely and truthfully. Attach additional sheets of paper, if necessary.

Name of Applicant/s:

Address:

Phone Number:

How long have you known the applicant/s?

What is the nature of your relationship?

How frequently do you see them and where?

Are there physical reasons the applicants or members of their family would make their home undesirable for a child? (Please explain)

Do you recommend that a baby/child be placed in the applicant’s home? If yes, why? If no, why?

Describe or characterize each of the applicants as to disposition, reputation, interests, relationship with each other, relationships with others, and relationships with children and community or church activities. Please give strengths and weaknesses.

Your Signature:

Date:

Print your name here:

Address: 

City, State, Zip:

Phone:

E-mail address:

Mail to: Embryos Alive, 7741 Pfeiffer Road, Cincinnati, Ohio 45242
Scan: e-mail embryosalive@yahoo.com