Packet B - New York - Wide Horizons for Children

Please be sure to read all instructions carefully, especially those related to the State of New York Criminal Background Checks and U.S. Citizenship and Immigration Services (USCIS).

We recommend you begin gathering these documents as soon as possible. Unless otherwise directed, you may send documents to WHFC as you receive or complete them, or submit all documents at once. Remember that we are here to help you every step of the way! Please don’t hesitate to contact us if you have any questions or concerns.

WHFC Forms

MEDICAL STATEMENT
Complete one for each person living in your home. Pages 1 and 2 are the form for adoption applicants. Pages 3 and 4 are the form for children and additional household members.
Last updated: 9/16/2020

RELEASE OF COUNSELING INFORMATION
If applicable
Last updated: 6/5/2008

AUTHORIZATION FORM
To release criminal conviction record information
Last updated: 5/13/2009

AFFIDAVIT OF HEALTH INSURANCE COVERAGE
Signed by either your employer or health insurer
Last updated: 1/1/2009

THREE (3) LETTERS OF REFERENCE
Please email your social worker names and email addresses for three reference writers. The writers should not be family members and should have known you at least three years.
Last updated: 11/19/2020

DOCUMENTATION OF ARREST HISTORY
If applicable. See enclosed instructions
Last updated: 1/15/2015

PRE-ADOPTION EDUCATION OVERVIEW
Last updated: 5/7/2020

Government-Issued Documents

BIRTH CERTIFICATE*
One (1) original or copy for each applicant

MARRIAGE LICENSE/ CERTIFICATE*
If applicable, one (1) original or copy

FINAL DIVORCE DECREE(S)*
If applicable, one (1) original or copy for each applicant

*NOTE: These documents must be civil (government-issued) records where the event was registered. We recommend obtaining at least five (5) original or certified copies (copies with an official raised seal) of all legal certificates for future use in completing adoption program dossiers and U.S. legalization procedures.