If You Are An Adoptee, Please Complete This Section
I was legally adopted at the age of_________ years/months
I was adopted in the United States:
City/County/State___________________________________________
I was adopted outside of the United States:
Country/City________________________________________
___I have always known I was adopted
-or-
At age ____, I learned I was adopted
-or-
___ I was never told by anyone that I was adopted
I learned about my adoption from
___ my adoptive mother/father
___ my adoptive sibling(s)
___ another adoptive relative(aunt,grandparent,etc)
___ my biological mother/father
___ my biological sibling(s)
___ another biological relative (aunt, cousin, etc.)
___ a non-relative (friend, school mate, attorney, etc.)
___ a public official
___ reading a document
Other_____________________________________
I am/was the only adopted member in my adoptive family: ___Yes ___ No
I have/had ____ no other sibling(s) in my adoptive family
I have/had ____ sibling(s) who were also adopted (How Many?)
I have/had ____ sibling(s) who were biological children of
my adoptive parent(s) (How many?)
I have/had ____ sibling(s) who were my biological brother/sister (How many?)
Following Are A Series Of Subjective Statements That Deal With Feelings And Emotions. Please Check
Any And All Responses That Apply To You.
Even though I always knew I was adopted, I felt that
___ I was treated differently than my family members by others
___ I was treated differently by my family members
Although I was never told I was adopted, I felt that
___ I looked different than my other family members
___ I was treated diffently than my family members by others
___ I was treated differently by my family members
Once I realized I was adopted, I felt
___ Special ___ Curious
___ Chosen ___ Ostracized
___ Different ___ Incomplete
___ Abandoned ___ Proud
___ Lucky ___ Indignant
___ Unloved ___ Shocked
___ More loved ___ Confused
___ Unique ___ Pleased
Please Answer By Checking Yes Or No To The Following Statements:
Based on my own adoption experience, if my situation was such that
I could not raise my own biological child, I would:
-give the child up for adoption ______ Yes ______ No
-have an abortion ______ Yes ______ No
-place the child with my
biological family members to raise ______ Yes ______ No
-attempt to raise the child regardless of my situation ______ Yes ______ No
Based on my own adoption experience, if my situation was such that
I could not have my own biological child, I would
-adopt a child ______ Yes ______ No
-foster a child ______ Yes ______ No
-live without children ______ Yes ______ No
Based on my own adoption experience, if I adopted a child, I would
-tell the child he/she was adopted as soon as he/she could
understand the concept ______ Yes ______ No
-never tell the child he/she was adopted ______ Yes ______ No
-tell the child about the adoption
when he/she reached age 18 ______ Yes ______ No
Since learning I was adopted, I have
-never been interested in searching
for my biological family
______ Yes ______ No
-always wanted to search for my biological family ______ Yes ______ No
-been fearful of searching for my biological family ______ Yes ______ No
-have/had a medical need to
search for my biological family ______ Yes ______ No
-searched for my biological family ______ Yes ______ No
-searched for my biological family
only after my adoptive family was deceased ______ Yes ______ No
-searched and located member(s) of my biological family ______ Yes ______ No
-searched, located and met member(s)
of my biological family ______ Yes ______ No
Please Check Any And All Answers That Apply To Your Situation:
I attempted to obtain information about my adoption and my biological family from
____ my adoptive family ____ a county government office
____ a private investigator ____ a federal government office
____ a hospital ____ a city government office
____ an orphanage ____ an "underground" search service
____ a "search" company ____ friends of my adoptive family
____ a library ____ a military office or official
____ an attorney ____ a mutual consent registry
____ public documents ____ the Internet/WWW
Other_________________________
I received general, non-identifying information on my biological family from
____ my adoptive family ____ my biological family
____ a private investigator ____ a county government office
____ a hospital ____ a federal government office
____ an orphanage ____ a city government office
____ a "search" company ____ an "underground" search service
____ a library ____ friends of my adoptive family
____ an attorney ____ a military office or official
____ public documents ____ a mutual consent registry
____ the Internet/WWW
Other_________________________
I received specific, identifying information on my biological family from
____ my adoptive family ____ my biological family
____ a private investigator ____ a county government office
____ a hospital ____ a federal government office
____ an orphanage ____ a city government office
____ a "search" company ____ an "underground" search service
____ a library ____ friends of my adoptive family
____ an attorney ____ a military office or official
____ public documents ____ a mutual consent registry
____ the Internet/WWW
Other_________________________
I was refused access to specific, identifying information on my biological family by
____ my adoptive family ____ my biological family
____ a private investigator ____ a county government office
____ a hospital ____ a federal government office
____ an orphanage ____ a city government office
____ a "search" company ____ an "underground" search service
____ a library ____ friends of my adoptive family
____ an attorney ____ a military office or official
____ public documents ____ a mutual consent registry
____ the Internet/WWW
Other_________________________
The one person or group or agency who ultimately provided me specific,
identifying information on my biological family was:
________________________________________________________________________
________________________________________________________________________
The search for specific, identifying information on my biological family took
____ no time ____ 1-2 years Other_________
____ 1 month ____ 2-3 years
____ 2-6 months ____ 3-5 years
____ 7 months to 1 year ____ 5-10 years
The search for specific, identifying information on my biological family cost
____ nothing ____ $1,001-2,500 ____ over $10,000
____ Less than $100 ____ $2,501-5,000
____ $101-500 ____ $5,001-7,500
____ $501-1,000 ____ $7,501-10,000
My expenses for accomplishing this search were paid from
____ my own personal funds
____ my adoptive family's funds
____ a bank loan
Other ____________________________________
I have searched and identified my
____ biological mother ____ biological father
____ biological sibling(s) ____ other biological family members
Even though I have identified members of my biological family,
I choose not to reunite with them because:
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Even though I have identified members of my biological family,
they chose not to reunite with me because
___________________________________________________________________________________________________________________________________
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If You Have Reunited With A Member Of Your Biological Family,
Please Complete The Following:
I have reunited with my
____ biological mother ____ biological father
____ biological sibling(s) ____ other biological family members
Since identifying and locating this biological family member, the reunion took place
____ within one week ____ within two weeks
____ within one month ____ within six months
____ within one year ____ within five years
Other __________________________
This reunion took place
____ at my home ____ at their home
____ in my city ____ in their city
____ in my state ____ in their state
____ in my country ____ in their country
Other _______________________________________________________
This reunion was initiated by ____ me ____ my biological family member
This reunion was arranged by ____ telephone ____ correspondence
Other _______________________________________________________
This reunion required me to travel by
____ automobile ____ airplane ____ train
____ public transportation
Other __________________________
This reunion required my biological family member to travel by
____ automobile ____ airplane ____ train
____ public transportation
Other __________________________
My expenses involved in arranging/attending this reunion were
____ nothing ____ $1,001-2,500
____ less than $100 ____ $2.501-5,000
____ $101-500 ____ over $5,000
____ $501-1,000
These expenses were paid from
____ my personal funds ____ my immediate family's funds
____ my adoptive family's funds ____ my biological family's funds
____ a bank loan
Other _________________________
At the time of our first face-to-face reunion, I was ______ years old.
At the time of our first face-to-face reunion, my biological family member
was ________ years old.
My feelings during the first face-to-face reunion with
my biological family member may be described as
____ tense ____ wonderful ____ relieved __________________
____ elated ____ angry ____ shocked __________________
____ pleased ____ happy ____ overjoyed __________________
____ overwhelming ____ thrilled ____ indifferent __________________
During the first face-to-face reunion, I perceived
my biological family member's emotions to be
____ tense ____ wonderful ____ relieved __________________
____ elated ____ angry ____ shocked __________________
____ pleased ____ happy ____ overjoyed __________________
____ overwhelming ____ thrilled ____ indifferent __________________
My first face-to-face reunion with my biological family member lasted
____ less than 1 hour ____ 4-6 hours
____ 1 - 2 hours ____ 1 day
____ 2 - 4 hours ____ more than 1 day -- How many ?______
Since my first face-to-face reunion with my biological family member
____ We have never met again ____ We meet once a month
____ We communicate by letter/telephone ____ We meet once a year
____ We meet once a week ____ We meet only occasionally
____ We now live together
In discussing the reasons for my adoption with my biological family member,
I was told the reason(s) for my adoption was(were)
____ economical -- my biological family could not support me
____ economical -- my biological family received compensation
for putting me up for adoption
____ economical -- my biological mother could not afford an abortion
____ moral -- my biological mother was not married
____ moral -- the family of my biological mother insisted that
I be put up for adoption
____ moral -- my biological mother did not believe abortion was an option
____ religious -- abortion was not an acceptable option
in my biological mother's religion
____ religious -- my biological mother was convinced by
a religious organization that adoption was the answer
____ health -- my biological mother could not raise me due to
her health problems
____ health -- my biological mother could not raise me due to
my health problems
____ emotional -- my biological mother did not want me
____ emotional -- my biological father did not want me
____ emotional -- the family of my biological parents did not want me
Please Give Us Your Personal Comments On Any Aspect Of Your Adoption Experience:
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