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Adopt America Network is planning to offer increased services to adoptive families in Northwest Ohio. You are the experts, and we need your input.

The following survey will help AAN to design the services that will specifically respond to adoptive families’ needs. Will you please help us help adoptive families like yours?

The survey should take you no more than 10 minutes to complete.

• We are not requesting any personal identification and will not make individual responses public in any manner. We are asking only for your zip code so we can plan locations for services to be offered.
• If you have adopted multiple children including sibling groups, we are providing five spaces for answers to questions that require responses for individual children.

Wendy Spoerl
Adopt America Network

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* 1. What are the child’s/children’s special needs/behavior issues?

(Please check all boxes that apply to your adopted children as a group.)

This question requires at least one choice.

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* 3. Why was the child/children in the foster system?

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* 4. Types of special medication the child/children receive(s)?