SCHEDULE VII
[See regulations 2(14), 10(8) and 21(2)]
HOME STUDY REPORT OF RESIDENT INDIAN PARENT OR OVERSEAS CITIZEN OF INDIA CARD HOLDER OR
FOREIGNER LIVING IN INDIA
Mr. ___________________________________
Ms. ___________________________________
Status of Prospective Adoptive Parents – Single or Married or Divorced or Separated or Widow or Any Other
All Prospective Adoptive Parents are required to register on the Designated Portal and adopt from the
authorised institutions.
DESIGNATED PORTAL REGISTRATION NO.
DATE OF REGISTRATION
PAN CARD NO. (MALE APPLICANT)
PAN CARD NO. (FEMALE APPLICANT)
AADHAR CARD NO. (MALE APPLICANT)
AADHAR CARD NO. (FEMALE APPLICANT)
PASSPORT NO. IF APPLICABLE
(MANDATORY IN CASE OF FOREIGN OR OCI
PROSPECTIVE ADOPTIVE PARENTS)
NAME OF THE SOCIAL WORKER OR ADOPTION OFFICER
NAME OF THE SPECIALISED ADOPTION AGENCY
ADDRESS OF THE SPECIALISED ADOPTION AGENCY
CONTACT NO. OF THE SOCIAL WORKER
E-MAIL ID
DATE OF HOME VISIT
Part-1 of the report is to be filled up by the prospective adoptive parents. The Home Study Report helps build a
strong proposal for the prospective adoptive parent (s) to adopt, and therefore, prospective adoptive parents
are expected to provide all information to the best of their knowledge. The prospective adoptive parents are
solely responsible for the authenticity of the information provided in the template and are required to sign
below on each page of Part-1. Any difficulty faced by the prospective adoptive parents in filling up Part-1 may
be shared with the social worker during the home visit.
Part-2 of the template is to be filled up by the professional social worker engaged by the Specialised Adoption
Agency or District Child Protection Unit or State Adoption Resource Agency. The Home Study Report helps assess
the suitability of the prospective adoptive parents to adopt. During the home study, the Social Worker shall
assess the financial, employment, health, lifestyle, home, and neighbourhood environments of the prospective
adoptive parents; their parenting styles or attitude(s) towards parenting; motivation for adoption; commitment
towards adoption and their overall readiness-cum-maturity to adopt. The social worker is also responsible for
providing pre-adoption counselling to the prospective adoptive parents.
Each and every page of the Home study report needs to be duly attested by the concerned social worker.
Duly Attested By Prospective Adoptive Parents (PAPs)
PART-1
To be filled (Printed) by the Prospective Adoptive Parents (PAPs)
A. Familiarity with Adoption
[This section can be filled up by either of the prospective adoptive parents]
(1) What is your motivation behind adopting a child?
__________________________________________________________________
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__________________________________________________________________
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(2) Will you be able to support an older child, a child with an addressable medical condition or a child with
special needs?
Yes or No.
If yes, kindly elaborate on the motivating factors for the same
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(3) Have you met any adoptive families or children who were adopted – if yes, how was your experience and
response
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(4) Are there any areas where you may need counselling or professional help in supporting the child you wish
to adopt – please provide details.
__________________________________________________________________
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(5) Please describe how the adoption shall affect other members residing with you and extend support to the
child
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Duly Attested By Prospective Adoptive Parents (PAPs)
B. Family background information:
PARTICULARS MALE APPLICANT FEMALE APPLICANT
Name (Underline Family Name)
Date of Birth
Place of Birth
Citizenship*
Address: Current
Address: Permanent
Email ID
Contact Phone No. and Mobile
No.
Religion
Language(s) spoken at home
Date of Marriage
Date of Earlier Marriage (if any)
Date of Divorce (if any)
Educational Qualification
Employment or Occupation
Name and Address of the
Present Employer or Business
Concern
Annual Income
Health Status
*In case of foreign citizenship, it is mandatory to mention details and attach copy of the passport. In such cases,
the No Objection Certificate from their Diplomatic Mission in India shall be required.
Duly Attested By Prospective Adoptive Parents (PAPs)
Photograph of the Prospective Adoptive Parents (PAPs)
(1) Provide following information about your parents.
Details about Parents of Male Applicant Female Applicant
the Applicants
Father Mother Father Mother
Name in full
Age
Nationality or Citizenship
Occupation
Previous occupation
Presently residing with
prospective Adoptive
Parent (Indicate Yes or
No)
(2) Please complete the following table with the details of each of your respective children (adopted and
biological).
Name of the Child Biological or Gender Date of Birth Educational
Adopted Status
Duly Attested By Prospective Adoptive Parents (PAPs)
(3) Please provide age, gender, occupation, and nature of the relationship of other family member(s) residing
with prospective adoptive parents
Name Nature of Age Gender Education Occupation
Relationship
(4) Please provide details of any other non-related adults or children living in the home(e.g., house help, staff,
outside personnel etc):
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
C. Professional or Employment Details (Professional career details for last five years): Please complete the
following table with details relating to your professional career.
MALE APPLICANT
Organisation Employer Details Job Title From
(Name and Address) To
FEMALE APPLICANT
Organisation Employer Details Job Title From
(Name and Address) To
Duly Attested By Prospective Adoptive Parents (PAPs)
D. Financial Status: (Give a short description of your income from all sources, savings, investments, expenditures,
debts, and liabilities).
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Please provide your most recent tax invoices, bank statements etc. of both of you.
Do you have any outstanding debts, mortgages etc.
(1) If yes, please provide supporting documentation:
(2) No
E. Current Marital Relationship (if applicable): (Give details about the marriage, legal separation, if any, reasons
for such separation, present marital life, and decision-making procedures).
(1) Please specify your marital status: __________________________________________
(2) Please describe the procedures you and your spouse use to reach a decision:
________________________________________________________________
________________________________________________________________
________________________________________________________________
F. Attitude of grand parents or extended family members, other relatives, and significant others towards the
present adoption: (Give a short description about the opinion of other important persons towards adoption
who shall have impact in the child rearing process when the child arrives in the receiving country.)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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G. Anticipated Plans of the prospective adoptive parents for taking care of the child:
(1) Please describe how you will manage caring for the adopted child and other life commitments such as
work.
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(2) Who shall be responsible for caring for the child when you are at work, or absent from the familial home
(domestic help, grandparents, and spouse).
__________________________________________________________________
__________________________________________________________________
Duly Attested By Prospective Adoptive Parents (PAPs)
(3) In case the adopted child demonstrates adjustment difficulties, please describe the steps that you plan to
take to ease their transition into the family.
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H. Preparation and Training for Adoption: (Give details about the pre-adoption counselling sessions or training
and or experiences related to child care, handling of needs of children, parenting children having special needs,
if any.)
Put a tick (✔) on the following as applicable:
(1) Understanding about adoption procedure:
(2) Reading of reference materials:
(3) Learning from friends or relatives:
(4) Interaction with adoptive parent’s groups:
(5) Learning through counselling from professionals:
(6) Video Modules on Adoption:
I. Possible Rehabilitation Plan for the child in case of any eventuality with prospective adoptive parents: (Give
a short description about your plan for the security of the child in case you face any short- or long-term
eventuality.
(1) Does your work require you to travel? Put a tick (✔) on the following as applicable:
Yes
No.
(2) Who shall care for the child in your absence? Please provide a brief description including their age, gender,
occupation, and relationship:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(3) In the event of unforeseen misfortune do you have someone who could take legal guardianship of child? If
so, Please provide a brief description including their age, gender, occupation, and relationship and contact
details:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
(4) In case you are a single prospective adoptive parent, please give a short description about the close relative
who shall be giving undertaking for the security of the child.
__________________________________________________________________
__________________________________________________________________
Duly Attested By Prospective Adoptive Parents (PAPs)
J. Health Status (Emotional and Physical):
(1) Do you or your spouse suffer from any medical condition? If so, kindly provide details?
__________________________________________________________________
(2) Are you or your spouse currently being treated by a psychologist or psychiatrist?
__________________________________________________________________
(3) Are you currently taking any prescribed medication?
__________________________________________________________________
(4) Is there currently any child(ren) in your house being treated for a severe medical condition?
__________________________________________________________________
(5) Does everyone in your family including you and your spouse have health and hospitalisation insurance
coverage for all family members?
__________________________________________________________________
K. Self-declaration
I or We certify that we are physically, mentally, emotionally, and financially capable, and do not have any life-
threatening medical condition and have not been convicted in criminal act of any nature or accused in any case
of child rights violation.
Put a tick (✔) on the following as applicable:
(1) Yes
(2) No
Name of the prospective adoptive parents
Signature of the Prospective Adoptive Parents (PAPs)
Date: ____/_____/_______
Place: _________________
Duly Attested By Prospective Adoptive Parents (PAPs)
