REFERENCE FORM Dear Friend or Family Member,Thank you for agreeing to be a reference! Please complete this electronic form and hit send once completed. Your support is greatly appreciated. Have questions about this reference form? Please feel free to email us at reference@connectingheartsadoption.com This reference is being completed for the following person or couple: * Name of Person Completing this Reference Form * First Name Last Name Email * Phone * (###) ### #### Date Form Completed * MM DD YYYY How do you know the applicant(s) & how long have you known them? * How often are you in contact with the applicant(s)? * How would you describe their lifestyle, religious and/or cultural activities? * How would you describe their home in terms of stability, communication, support network, etc? * What words would you use to describe the applicant(s)? * Describe their interactions with children. * What special qualities will they bring to parenting? * Are you aware of any aspects of their background or personality that may interfere in the successful parenting of a child? If yes, please explain. * Do you have any doubts, reservations or hesitations about the applicant(s)? * Are there any other comments you would like to share? * Do you believe this will or will not make a good adoptive home? If yes, why? * Thank you! Your reference has been received.