Ariz. Admin. Code § R21-5-404 - Application for Certification

An applicant who wishes to become certified as an adoptive parent shall apply for certification as provided in A.R.S. § 8-105. An adoption entity shall require an applicant to provide at least the following information:

1. Personally identifying information for each prospective adoptive parent, including:

a. Name and date of birth;

b. Social Security number;

c. Race and ethnicity;

d. Physical description;

e. Current address and duration of Arizona residency;

f. Marital history; and

g. The name, address, and phone number of immediate family members, including emancipated adult children;

2. The name, date of birth, and social security number of any person currently residing with the applicant;

3. A listing of the applicant's insurance policies, including:

a. Any insurance that may be available to cover the medical expenses of a birth mother or adoptive child; and

b. The name of the insured, the insurance policy number, and the effective dates of coverage;

4. A current financial statement describing the applicant's assets, income, debts, and financial obligations;

5. A physician's statement as to the applicant's current physical and mental health;

6. A medical and psychological history on the applicant and the applicant's household members. The history may be a declaration by the applicant of past physical and mental illness for the applicant and any household member;

7. The applicant's employment history;

8. The applicant's social history;

9. A statement from the applicant as to the type of child the applicant seeks to adopt and whether the applicant desires to adopt or would consider adopting a child with special needs;

10. Information on the following legal proceedings in which the applicant has been a party:

a. Dependency proceedings,

b. Severance or termination of parental rights proceedings,

c. Child support enforcement proceedings,

d. Proceedings involving allegations of child abuse or neglect,

e. Adoption proceedings, or

f. All criminal proceedings;

11. The applicant's prior history of adoption certification, including prior applications for certification and the dates of any certification denials;

12. Whether the applicant wishes to be listed on the Adoption Registry;

13. A fingerprint card or fingerprints processed through the Court, meeting the requirements of A.R.S. § 41.1758.07 on each applicant and each adult residing in the home more than the age of 18 years; and

14. The names, addresses, and phone numbers of five personal references; two references from family members related to the applicant by blood or marriage, and three other references, who have known the applicant at least two years and who can attest to the applicant's character and fitness to adopt.

Notes

Ariz. Admin. Code § R21-5-404

New section made by exempt rulemaking at 21 A.A.R. 3256, effective 1/24/2016.