"" 1 Your Name Your Last Name Birth Father Contact Information Father's Namefull nameno-icon Addressno-icon Date of Birthdate_range Ageno-icon Place of Birthno-icon SS#no-icon PhoneHomeno-icon PhoneCellno-icon Emaila valid emailemail Husband Contact Information (if applicable) Nameno-icon Phoneno-icon Is your husband a member of a Native American tribe or Alaskan Village?YesNo US CitizenYesNo Does your husband live on a reservation?YesNo What tribe or village?if yesno-icon Is husbandin the armed forces?YesNo What branch and dates of service?if yesno-icon Dateof birthdate_range Ageno-icon Birth Placeno-icon SS#no-icon Is he aware of the pregnancy?Yes No Is he aware of your adoption plan?YesNo Is he willing to consent to adoption?YesNo NEXT Previous Next