Inquiries Online Form
Thank you for your interest in Hands Across The Water. A staff person will reach out to you soon to follow up.
*As an agency, we are constantly working to improve our services to all of our clients. We collect demographic information to assist us in establishing goals, maintaining accountability, and for contract and accreditation reviews. The data is tracked in aggregate form (not individually). There is always a "prefer not to answer option" available for any field you prefer not to share with us.
Applicant 1
Ap 1 Legal First Name
*
Ap 1 Preferred Name
Ap 1 Legal Middle Name
Ap 1 Last Name
*
Ap 1 Race/Ethnicity
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American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, Latinx, or Spanish Origin
Middle Eastern or North African
Multiracial/Other
Native Hawaiian or Other Pacific Islander
Prefer not share/did not share
White or Caucasian
Ap 1 Gender
*
Male
Female
Non-binary/genderqueer
Genderfluid
Agender
Other
Prefer not to answer
Ap 1 Transgender
*
Yes
No
Prefer not to answer
Ap 1 Preferred Pronouns
*
Ze/Hir
They/Them
Ze/Zir
He/Him
She/Her
Prefer not to share
Ap 1 Sexual Orientation
*
Heterosexual/straight
Homosexual/gay/lesbian
Asexual
Pansexual
Queer
Questioning
Bisexual
Other
Prefer not share/did not share
Date of Birth
*
Contact
Preferred Contact Method
*
Home Phone
Home Email
Ap 1 Email
Ap 2 Email
Ap 1 Work Email
Ap 2 Work Email
Ap 1 Cell Phone
Ap 2 Cell Phone
Ap 1 Work Phone
Ap 2 Work Phone
Home Phone
Enter International
Home Email
*
Ap 1 Email
*
Ap 2 Email
Ap 1 Cell Phone
*
Enter International
Ap 2 Cell Phone
Enter International
Applicant 2
Ap 2 Legal First Name
Ap 2 Preferred Name
Ap 2 Legal Middle Name
Ap 2 Legal Last Name
Ap 2 Race/Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic, Latino, Latinx, or Spanish Origin
Middle Eastern or North African
Multiracial/Other
Native Hawaiian or Other Pacific Islander
Prefer not share/did not share
White or Caucasian
Ap 2 Gender
Male
Female
Non-binary/genderqueer
Genderfluid
Agender
Other
Prefer not to answer
Ap 2 Transgender
Yes
No
Prefer not to answer
Ap 2 Preferred Pronouns
Ze/Hir
They/Them
Ze/Zir
He/Him
She/Her
Prefer not to share
Ap 2 Sexual Orientation
Heterosexual/straight
Homosexual/gay/lesbian
Asexual
Pansexual
Queer
Questioning
Bisexual
Other
Prefer not share/did not share
Date of Birth
Residence Address
Street Address
*
Street Address Line 2
City
*
State/Region
*
Select US-State
AK - Alaska
AL - Alabama
AR - Arkansas
AS - American Samoa
AZ - Arizona
CA - California
CO - Colorado
CT - Connecticut
DC - District of Columbia
DE - Delaware
FL - Florida
FM - Federated States of Micronesia
GA - Georgia
GU - Guam
HI - Hawaii
IA - Iowa
ID - Idaho
IL - Illinois
IN - Indiana
KS - Kansas
KY - Kentucky
LA - Louisiana
MA - Massachusetts
MD - Maryland
ME - Maine
MH - Marshall Islands
MI - Michigan
MN - Minnesota
MO - Missouri
MP - Northern Mariana Islands
MS - Mississippi
MT - Montana
NC - North Carolina
ND - North Dakota
NE - Nebraska
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NV - Nevada
NY - New York
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
PR - Puerto Rico
PW - Palau
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VA - Virginia
VI - Virgin Islands
VT - Vermont
WA - Washington
WI - Wisconsin
WV - West Virginia
WY - Wyoming
Enter Region
Zip Code
*
County
*
Country
United States
Afghanistan
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Algeria
American Samoa
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Antarctica
Antigua and Barbuda
Argentina
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Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
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Korea, North
Korea, South
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Latvia
Lebanon
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Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Referral Info
How did you hear about us?
Agency Referral
Billboard
Church
Client Referral (please specify below)
Facebook
Foster Care Recruitment
Friend
HATW staff member
HATW Website
HRC website - All Children All Families Designation
MARE
MFCP
Navigator Program
Other
Prospective Adoptive Parent
Relative in need of care - DHHS
USCIS
Web Search
Word of mouth
Please provide the name of the specific persons or places
Inquiry Services Interested In
*
Domestic Infant
International
Foster Care Licensing
Waiting Child Adoption
Other
Memo
Additional Information
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