Grant Application Form

Please enable JavaScript in your browser to complete this form.

NAME OF GRANT APPLICANT(S)

DATE OF APPLICATION

Family Photo *

Drag & Drop Files, Choose Files to Upload

If willing, please attach a current family photo here or attach a family photo to your email when submitting your application

Save and Resume Later

INFORMATION OF ADOPTING PARENT(S)

Address

Address Line 1

Address Line 2

City

State

Zip Code

APPLICANT 1

Full Name

Age

Primary: Phone

Employer

Job Title

Do you live in Georgia?

If so, how long have you lived here?

If married, number of years married to current spouse Years

APPLICANT 2

Full Name

Age

Primary: Phone

Employer

Job Title

Do you live in Georgia?

If so, how long have you lived here?

Our committee prioritizes applicants with a connection to Georgia. If you do not currently live in Georgia, please let us know if you have some other connection to Georgia.

How did you hear about the CFLM Adoption Assistance Grant?

Save and Resume Later

CHILDREN INFORMATION

Checkbox

I/We do not currently have children.

Name of Child

Age

This child is:

Biological
Adopted

Save and Resume Later

FAITH INFORMATION

Name of Church

Church Street Address

Address Line 1

City

State

Zip Code

Church Phone Number

Church Website

Years of Attendance at this Church

STATEMENT OF FAITH

Please visit chosenforlifeministries.org/statementoffaith and sign below to indicate that you
have read and agree to our Statement of Faith

Applicant 1 Signature *

Drag & Drop Files, Choose Files to Upload

Applicant 2 Signature *

Drag & Drop Files, Choose Files to Upload

PERSONAL STATEMENT

CFLM requires a typed personal statement from each applicant. Your typed statements
should include:

- A brief testimony of your faith
- Your reasons and journey toward the decision to adopt
- Any impact your decision to adopt has had on your life
- How receiving a grant will impact you and your family

Attach your statements after this page of the application with handwritten signatures and dates signed at the bottom of each.

Save and Resume Later

PASTORAL REFERENCE

Please request a typed reference letter from your lead or associate pastor* on church letterhead with his/her signature

*If you attend a larger church, at which your lead pastor does not have a personal relationship with your family, you may provide a reference from another leader of your church (ex: children’s ministry director) or a leader of a Sunday school class or small group that you are regularly involved with

Pastor’s Full Name

May We Contact Your Pastor?

Pastor’s Phone Number

Pastor’s Email Address

My pastor’s reference letter

Is included in Application
Has Been Emailed to CFLM

File Upload *

Drag & Drop Files, Choose Files to Upload

Save and Resume Later

PERSONAL REFERENCES

Please request a typed letter from two personal references* answering the following questions:

1. How do you see these applicants living out the gospel in their daily lives?

2. Explain why you think these applicants should be awarded financial assistance for their
adoption
*Please note that we strongly recommend references from non-family members.

References may provide their letters in the following ways:

1. Provide you with a hardcopy of their typed reference letter with handwritten signature
to be included with the application and attached after this page.

2. Email the typed reference letter directly to [email protected] with subject
line: “Grant Reference – Applicants’ First and Last Names.” References need not carbon
copy (cc) the couple applying for assistance.

PERSONAL REFERENCE INFORMATION - Number #1

Family Member
Friend

Reference’s Full Name

Address

Address Line 1

City

State

Zip Code

Phone

Number of Years Applicant Has Known Reference

May We Contact Your Reference?

Reference Letter #1

Is included in Application
Has Been Emailed to CFLM

Upload Reference Letter 1 *

Drag & Drop Files, Choose Files to Upload

PERSONAL REFERENCE INFORMATION - Number #2

Family Member
Friend

pastor’s Agent/Agency Age

Reference’s Full Name

Address

Address Line 1

City

State

Zip Code

Phone

Number of Years Applicant Has Known Reference

May We Contact Your Reference?

Reference Letter #1

Is included in Application
Has Been Emailed to CFLM

Upload Reference Letter 1 *

Drag & Drop Files, Choose Files to Upload

Save and Resume Later

HOME STUDY AGENT/AGENCY INFORMATION

Is this Agency Licensed?

Name of Agent/Agency

Name of Agent/Agency Contact

Address of Agent/Agency

Address Line 1

City

State

Zip Code

Phone Number

Home Study Date of Completion (mm/yy)

Is your Home Study Agent/Agency the same as your Placement Agency?

PROOF OF HOME STUDY COMPLETION

Please have your agency provide a statement-of-completion for your approved home study on company letterhead. (NOTE: Please do NOT include a copy of your full home study.) Your agency may email this directly to [email protected]. ADOPTION PLACEMENT AGENCY INFORMATION (if different from Home Study Agency

Name of Agent/Agency

Name of Agent/Agency Contact

Address of Agent/Agency

Address Line 1

City

State

Zip Code

Phone Number

Please attach a copy of both your home study agency and child-placing agency’s licenses. *

Drag & Drop Files, Choose Files to Upload

Briefly share your reason for choosing your placing agency.

Save and Resume Later

OTHER ADOPTION INFORMATION

Have you received an Adoption Assistance Grant from CFLM in the past?

Did you use or are you currently using a paid consultant/facilitator?

facilitator's name

(Please note: CFLM cannot provide financial assistance toward any consultant/facilitator expenses.)

Have you already been matched through your child-placing agency?

Have you been matched with

An older child
A child with special needs
More than one child?

How many children?

What country are you adopting from?

What is your interest in that particular country? Please explain in the space provided below.

What have you done to prepare for your adoption? (What courses have you taken? What books have you read? What resources do you have available to you once you complete your adoption?)

Have you ever attended a CFLM Choosing to Care Conference?

Number of times

Have you ever attended a CFLM Learning to Care Workshop?

Number of times

Have you ever attended a Show Hope Empowered to Connect Simulcast?

Number of times

Have you ever volunteered as a CFLM Advocate or Care Team Volunteer?

Save and Resume Later

NET WORTH

Gross Salary/Wage

Investment Income

Other Income ?

Total Income

Other Income

Write Description

Assets

Cash

Checking Accounts

Savings Accounts

Investment Accounts (other than retirement)

Life Insurance Cash Surrender Value (not death benefit)

Retirement Accounts

Value of Autos

Value of Home (if owned)

Approximate Value of Household Items

Value of other items

Total Assets

You own not listed above

Write Description

Liabilities

Home Mortgage Balance

Auto Loan Balances

Student Loan Balance

Credit Card Balances

Balances of Past Due Bills (excluding credit cards)

Any Other Amounts Owed ?

Total Liabilities

Amounts

Write Description

Net Worth (Assets - Liabilities)

Save and Resume Later

ADOPTION EXPENSES & FUNDING SOURCES

Please provide your adoption expenses. If the expense does not apply to your adoption, simply leave it blank.

Agency Fees

Visas

Home Study Fee

Overseas Fees

Facilitator Fee

Travel Costs

Birth Mother Expenses

Orphanage Fees

Attorney Fees

Foreign Program Fee

INS Fees

Child’s Medical Exam

Notarization/Authentication Fees

Other

In-country Fees

Other

Total Adoption Expenses: $

Please detail any fundraising or grant awards you have received thus far:

Grants Awarded

Amount

Funds Received

Funds Used

Matching Grant

Please list any grants that you have applied for, but have not yet received determination for

Please list any additional fundraising that you have planned or completed.

Fundraising Type

Completed/Planned

Completed
Planned

Amount Raised

Amount Projected

Total Fundraising to Date: $

Total Expected Personal Contribution: $

Total Need: $

(Total Adoption Expenses – Fundraising – Personal Contribution)

Save and Resume Later

APPLICATION CHECKLIST

These items will need to be attached to your application.

Page 1 of Application (Application Cover Page - Name, Date, Family Photo)
Page 2 of Application (Parents’ Information)
Page 3 of Application (Children Information)
Page 4 of Application (Faith Information – Church)
Typed Statements of Faith of both parents, with handwritten signatures and dates at bottom
Page 5 of Application (Pastoral Reference Information)
Pastor’s Reference Letter on letterhead with signature (if not emailed directly to CFLM)
Page 6 of Application (Personal Reference Information)
Personal Reference Letter #1 (if not emailed directly to CFLM)
Personal Reference Letter #2 (if not emailed directly to CFLM)
Page 7 of Application (Agency Information)
Statement-of-completion from home study agency on letterhead (do NOT include full home study)
Copy of license for home study agency on agency letterhead
*Copy of license for placement agency (if different from home study agency)
Page 8 of Application (Other Adoption Information)
Page 9 of Application (Financial Assessment)
Copy of most recent Paystub & W2
Copy of Adoption Expense Fee Schedule
Document detailing fees paid to consultant/facilitator (if applicable)

FOSTER CARE

ADOPTION

GET INVOLVED

TRAINING & EVENTS

WHO WE ARE

Secure Application Form

INFORMATION OF ADOPTING PARENT(S)

APPLICANT 1

APPLICANT 2

CHILDREN INFORMATION

FAITH INFORMATION

STATEMENT OF FAITH

PERSONAL STATEMENT

PASTORAL REFERENCE

PERSONAL REFERENCES

HOME STUDY AGENT/AGENCY INFORMATION

PROOF OF HOME STUDY COMPLETION

OTHER ADOPTION INFORMATION

NET WORTH

Assets

Liabilities

ADOPTION EXPENSES & FUNDING SOURCES

Please detail any fundraising or grant awards you have received thus far:

Please list any additional fundraising that you have planned or completed.

APPLICATION CHECKLIST