Submit Inquiry

*Type of Inquiry: Select Type of Inquiry Adoption Foster Care & Adoption Foster Care

*Family Structure:

Married Couple

Married but individually adopting or obtaining legal guardianship

Separated

Single Adult

Unmarried Couple

*Secondary Caregiver information will be optional. However, if the Family Structure is Married or Unmarried Couple or any of the fields in the Secondary Caregiver section are entered/selected, then all the requirements that exist for Primary Caregiver will apply to Secondary Caregiver.

Primary Caregiver

*First Name:

Middle Name:

*Last Name:

Maiden Name / Previous Name:

*Date Of Birth:

*Race:

American Indian / Alaskan Native

Asian

Child abandoned - unable to determine

Black or African American

White

Incapacitated or unable to inform

Declined to disclose

Native Hawaiian or Other Pacific Islander

Multiracial - races unknown

*Hispanic: Yes No

*Biological Sex: Female Male

*Current Cabinet for Health and Family Services Protection and Permanency (P&P) Employee: Yes No

*Email Address:

*Contact Number: Cell Phone Home Phone Work Phone

Secondary Caregiver

*First Name:

Middle Name:

*Last Name:

Maiden Name / Previous Name:

*Date Of Birth:

*Race:

American Indian / Alaskan Native

Asian

Child abandoned - unable to determine

Black or African American

White

Incapacitated or unable to inform

Declined to disclose

Native Hawaiian or Other Pacific Islander

Multiracial - races unknown

*Hispanic: Yes No

*Biological Sex: Female Male

*Current Cabinet for Health and Family Services Protection and Permanency (P&P) Employee: Yes No

*Email Address:

*Contact Number: Cell Phone Home Phone Work Phone

Household Address

*Street No:

Apt No:

*Street Name:

*City:

*County: Select County Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox LaRue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon McCracken McCreary McLean Madison Magoffin Marion Marshall Martin Mason Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford

State: Kentucky

*Zip:

Zip Plus 4:

What prompted the inquiry
TELEVISION

Adoptathon

Wednesday's Child

WBKO FEC Adoption Program

PRINTED MATERIAL

Promotional Materials (i.e. Yard signs, brochures, etc.)

Billboards/Buses/Advertisements

NEWSPAPER

News Special/Human Interest Stories

WORD OF MOUTH

Adoption Support for Kentucky

Foster Adoptive Training Support Network

Friend/Relative/Coworker/Community Member

PCC Agency/Community

Current or Former Foster/Adoptive Parent

OTHER

CHFS Website or Social Media

AdoptUSKids

KAPE Website

PCC/Out of State Transfer

Previous Foster/Adoptive Child

Other

KY FACES Website

Thursday's Child

Kentucky's Kids Belong/America's Kids Belong

Facebook

ACTIVITY

Church

Fairs/Festivals

Kentucky State Fair

RADIO

PSA (Public Service Announcement)

Interview/Segment

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