The following is a sample of the components that will be included in your home study

DATE OF COMPLETION:
February 1, 2010

John and Debbie Davis
1234 Family First Drive
Your Town, Utah 84000
000-000-0000

INTERVIEWS: With the couple – January 1, 2010
                   With John – January 1, 2010 & January 4, 2010
                   With Debbie – January 1, 2010, January 4, 2010

LOCATION: Davis residence
INTERVIEWER: Alan T. Saunders, Ph.D., L.C.S.W.

IDENTIFYING INFORMATION:

Adoptive Father: John William Davis
Date of Birth: January 1, 1980
Birthplace: Home Town, Utah
Ethnic Background: Your ethnicity
Physical Description: Height 6’0” and 180 lbs.  Blond hair and blue eyes.
Social Security # 123-45-6789
Driver's License UT #12345

Adoptive Mother: Debbie Lois Davis
Date of Birth: January 1, 1980
Birthplace: Home Town, Utah
Ethnic Background: Your ethnicity
Physical Description: Height 5’2” and 140 lbs.  Brown hair and hazel eyes.
Social Security # 123-45-6789
Driver's License UT #12345

CHILDREN CURRENTLY LIVING IN THE HOME:

The Davis family has one adopted child Billy who was born on January 1, 2005.  He loves to sing songs, eat fruit, play with his toys and he has a kitches set he loves to "cook" in.  He has always been full of energy and is very inquisitive.  Billy is healthy, happy and do very well in the Davis home.  Adopting Billy has been one of the highlights in their lives. The family also has a dog.  There are no others living in the home.

REASON FOR HOME STUDY/ADOPTION:

The Davis’ have been married for 9 years and they are incapable of having children.  Debbie has a medical condition.  They have had many treatments and have utilized all medical advice for becoming pregnant including artificial insemination and many other tests.  All medical attempts have been unsuccessful.  The couple met in Home Town, Utah and they have lived in their home for 2 years.  After they married, they wanted children.  They have successfully adopted one child and have had such good experiences with Billy who is now 2 years old.  They wish to adopt again because adopting Billy has been so positive.

Adoptive Father:

John Davis was born on February 12, 1960, in Home Town, Utah (confirmed with birth certificate). He was the first of three children for Jim and Mary Davis. His father, age 65, was a successful stock broker and is now retired. His father's financial success allowed his mother, age 63, to stay home and raise their children full time. He has a sister Samantha and a brother Steve, 29 and 25 respectively. Samantha lives with her spouse Bobby Jones and their two children, Jessica and Spencer, in Their Town, Utah. Steve is obtaining a degree in Accounting from University and is currently single. They are all in excellent mental and physical health.

John grew up in a very family oriented environment. They all regularly attended Church Of Pleasant, where they were actively involved in both church and community functions. Being a close-knit group the entire family would attend any activity involving another member. They also took vacations together, whether it was a long weekend to go camping or a few weeks during the summer to see some part of the country. One of his favorite trips was to the Grand Canyon. As a young man he was encouraged to be involved with school clubs and sports, as a result he had many friends. All his friends were always welcome in their home to participate in the family's festivities.

As a child singing in the church choir, John, first realized his love for music and has gone on to have several songs published. In addition to writing music, he enjoys reading and landscaping their yard. He has planted several trees and flowerbeds while maintaining a flourishing garden. He still enjoys playing sports and is involved along with Debbie in church volleyball and softball leagues. Although you will hear John joke, "Debbie can't play! She runs from the ball if it comes near her!" She really is a good ball player. Occasionally he will play racquetball or basketball at the community center.

John says he grew up in a wonderful and loving environment and hopes to provide the same for his children. He is still very close to his family and they normally get together every couple of weeks to have a bar-b-que. He describes himself as an out-going, musically inclined, faithful, and caring man, who believes family is the most important thing in life.  John is a graduate of Pleasant University with a degree in Music Education in 1983. He graduated with honors.  John is a music teacher for a Pleasant High School. (Confirmed) He has been with this school since his college graduation in 1983. In the summer, he works as a part time salesman for Sears.

Adoptive Mother:

Debbie Davis was born May 30, 1961 in Home Town, Utah. She is thirty-one years old and the middle child of Lyle and Mary Williams. After forty years as a manufacturer's representative for several machine tool companies, her 64-year-old father plans to retire next year. Besides high blood pressure that is thought to be a result of being overweight, her father is in good health. Debbie's mother is 62 years of age and also in good health. She is employed as a part time occupational therapist that plans to retire at the same time as Lloyd. Regarding siblings, Debbie has a brother and a sister, named Curtis and Cathy. Curtis is thirty-five and married Joan. They have three lovely daughters. JoAnn is ten. Cindy is eight. Marci is four. They live in Anywhere, Texas. Cathy is twenty-nine and married John Logan. They have one son, Ben who is three. They live in Anywhere, California.

While she was growing up, Debbie always felt special to her parents. Debbie always felt loved and cared for. Religion was important but not a dominant force in her upbringing. It was common for her father to frequently travel because of his job. Lloyd despite his time away always seemed to find the time to take the family on an annual two-week vacation. He also arranged for them to go on numerous business trips with him over the summer. Even though Lloyd traveled and was often away from home, Debbie still felt he greatly influenced her life. Debbie's mother always made the best out of the worst situation. It was not uncommon for her mother to make Debbie and Cathy's clothes.

Debbie was involved with numerous school activities while growing up. She was active in a group called "Rainbow" girls. Debbie loved theater and auditioned for all school theatrical productions. It was normal for Debbie to acquire the lead roles in most productions. Beyond theater, she enjoyed singing, sewing, knitting, watching TV, and playing softball. Debbie was a very good athlete and she still boasts that she can catch a ball better than John can.

Debbie's family was then and still is very close. She has fond memories of her childhood. Debbie does not see her brother as much as she would like, but understands the chaos that managing three children can bring. Debbie is generally closer now with her sister Cathy. They usually talk at least every two weeks.   Debbie graduated in 1984 with her bachelor's degree in elementary education from Pleasant University.   Debbie has been employed since 1984 as a third grade elementary teacher at Pleasant Elementary in Pleasant, Utah. (Confirmed). She plans on quitting her job upon placement of a child. She plans to resume teaching once her child is old enough to start school.

Insurance Coverage:

LIFE: John has life insurance with Pleasant Mutual Life valued at $100,000.00. Debbie has life insurance with the same company valued at $50,000.000. 
HEALTH: They are covered with Pleasant Shield Major Medical. (Verified) It covers the baby from time of placement. They must wait twelve months for pre-exiting conditions.

CRIMINAL BACKGROUND CHECK:

John and Debbie have completed a criminal background check with The State Utah Bureau of Criminal Identification.  A report was received for both Debbie and John.  Each of the reports is dated 1/03/2010 and contains the verbiage “No Criminal Record Found.” John and Debbie also completed a child abuse check with Utah Division of Child and Family Services.  A report was received for both Debbie and John.  The report is dated 1/03/2010 and contains the verbiage “there were no supported or substantiated records found naming the above person(s) as perpetrator of child abuse, neglect, or dependency.” 

Neither John nor Debbie has been the perpetrator of a crime and have not been arrested.  Neither has been a perpetrator of physical, emotional, or sexual abuse nor a victim of physical, emotional, or sexual abuse.

HISTORY OF ABUSE, NEGLECT, DOMESTIC VIOLENCE, SUBSTANCE ABUSE:

John and Debbie spoke openly about their background, upbringing and their family.  They have never participated in drug and alcohol use or abuse.  They believe strongly in abstaining from these substances are teaching their child the same and have strong religious beliefs in this regard.  The matter of drugs and alcohol was handled in their family of origin by their parents teaching them to abstain completely because of strong religious beliefs and they were encouraged to talk to their parents if there were any issues related to drugs or alcohol.  In their families, they do have a individuals who have struggles with drugs and alcohol.  The family shields their child from this and they do not have much contact with them.  If they do visit, they are respectful and do not use substances in front of them.  They have specifically talked with each other about the issues relating to drug and alcohol abuse and have discussed that if a problem developed in their family it would be handled utilizing natural consequences including intervention, discussions and rational teachings about the detrimental effects of alcohol and drug use. 

Both John and Debbie denied that they have been the victims of child abuse.  They denied that they had ever committed or been accused of an act of abuse on any child or ever committed or been accused of an act of abuse or neglect on any disabled person or adult.  They have not been the victims of any type of assault or domestic violence and have not been accused of an act of domestic violence.  They have never broken or been accused of breaking the law. The criminal background reports received supports this.

HOME AND NEIGHBORHOOD:

The Davis's home is tucked away on a quiet residential street located in the town of Anywhere, Utah. Their neighborhood is pleasantly supported with good neighbors and children of all ages. Their church and school are both within walking distance of their home.

Their home has approximately 3200 square feet and is two stories. The first floor contains a living room, dining room, kitchen, laundry room and half bath, and a small room that can be used as a playroom. The second floor contains three bedrooms with walk in closets and a full bath. The home is tastefully furnished and housekeeping standards are good.

The Davis' are buying their home. They have lived at this address for the past three years. They do not have any plans to move in the near future.

LETTERS OF REFERENCE:

All reference letters are positive and supportive of the Davis' plans to adopt. One reference said, "They are unique among our friends as responsible, kind and outgoing. " Letters have been received from three friends, a family member and their spiritual leader. Letters were received from Todd Samuels of His Town, California; Mrs. John (Brenda) Betty, Anywhere, Utah; Mr. and Mrs. Greg Carter, Anywhere, Utah; Mrs. Jim (Shelly) Pinto, Anywhere, Utah and Steven D. Richards, Home Town, Utah.

PARENTING THE PREPARATION FOR ADOPTION:

The Davis' are excellent loving parents. Billy receives appropriate suggestions for his age as well as proper punishment by way of time out. Talking and explanations are ways John and Debbie help Billy to learn right from wrong. They generally enjoy family outings and often involve Billy in the planning's of such outings. Billy repeatedly suggests the park.  Two days a week, the Davis' send Billy to a day care. The other three days a week he stays with a licensed day care provider while the Davis' are teaching. During the summer, he stays at home with his mother.

The Davis' are willing to meet with the birth parent if that is their desire. They wish to be identified only on first name basis. They are willing to send pictures and letters to the birth parent(s) as well as receive letters from the birth parent(s) via the adoption agency. They feel comfortable sending letters and pictures every three months for a year. At the end of that year, they will then decide if they will continue contact.

MARITAL RELATIONSHIP:

John and Debbie met while attending the University. After only a few dates, they decided to date exclusively. Debbie states it was "love at first sight" for her. For John, the love grew greater with each date and their interactions together. John has been so pleased that his feelings for Debbie have grown so deeply.  After graduation, he married Debbie.  They were married March 4, 1983 at the local Church, in Home Town, Utah. (Confirmed by marriage certificate).

Debbie and John family backgrounds were very similar. John and Debbie share similar hobbies. When either is involved in separate activities the other is very supportive. Debbie and John both feel that they can discuss anything and naturally share their most intimate feelings. They feel they are "best friends".

OCCUPATIONAL/EDUCATIONAL:

John and Debbie have been very specific about educating Billy and teaching him values including the importance of work by providing opportunities for him to do small jobs and have responsibilities in their home.  Debbie supports John in his employment and John supports Debbie in hers.  They have established a good balance between work and fun.  Debbie has been the primary care giver of Billy.  They also have good family support including parents, siblings, aunts and uncles and a very supportive neighborhood.  They do not perceive any conflicts between their work schedule and the time required to care for another child. 

EXTENDED FAMILY:

There is tremendous positive support that can and has been rendered by their extended family to the family and to Billy and any adopted children. They have discussed adoption extensively with the extended family members and they are very supportive of this decision.  They have discussed and considered with their family how the family members will feel, think, and act about a child of a different race and/or culture than some family members.  Debbie’s family is of mixed heritage, John’s is Caucasian only. The issue of the family treating an adopted child different than a biological child has been discussed and addressed.  There are specific family traditions, and celebrations throughout the year including every holiday, family birthdays and family vacations that the adoptive children will benefit from by entering this family.

RELIGIOUS INVOLVEMENT:

John and Debbie are members of the local Church.  They are active in their church and community with much involvement and a great deal of their time is volunteered.  Religion has played a significant role in their moral/personal growth and development by providing them stability and firm beliefs in God and that there is a specific purpose for their existence and for their adherence to eternal principles.  The church does have extensive family services and support that is offered to families including issues related to adoption.

FINANCIAL RESOURCES:

The Davis' have a gross combined annual income of $84,000 with a net income of $66,000. (Verified by IRS statements) John has an annual gross income of $42,000. Debbie has an annual gross income of $42,000 as well.

They have approximately $100,000 in assets. This consists of $10,000 in cash savings and checking accounts, $20,000 in stocks and bonds, $30,000 vested in a retirement plan through both of their employers. Their home is valued at $200,000 and they have a thirty-year mortgage with a balance of $160,000. They pay $1100 a month on the mortgage and that includes insurance. Together with car payment, house payment, utilities, food, insurance, etc. they pay out approximately $4000 per month. They have enough left over that they can well afford a child into their family.

MEDICAL EVALUATIONS:

John is in good health. He had the usual childhood illnesses. He has experienced no surgery or serious illness. He sees Dr. Good and was last seen on 11/1/08.  Debbie is in good health. She had the usual childhood diseases. She has had extensive treatment for her infertility. She is physically capable of parenting a child. Her doctor is Dr. Sullivan and she was last seen on 11/1/08. The family pediatrician is Dr. Butler who recently evaluated Billy and found him to be in good health.

GUARDIANSHIP:

In case of untimely deaths, the Davis' have selected John's sister and brother-in-law, Samantha and Bobby Jones of Their Town, Utah to be the legal guardians of their children. They feel Mr. and Mrs. Jones would be wonderful parents because they currently have two lovely children. They additionally are financially secure as Danny has a career as an attorney. The Davis’ currently are in the process of making a will. They have a verbal agreement in place regarding this guardianship arrangement.

CHILD TO BE ADOPTED:

The Davis' will consider a boy or girl from a newborn to a toddler. They will consider only a Caucasian child. It is possible Debbie and John will accept a child with mild handicaps such as clubfeet, cleft palate, etc. They, however, will not accept a child with any neurological or mental handicaps. It was explained to them that it is often impossible to determine such neurological and most mental handicaps at birth. They will consider twins or a sibling group with the older child not exceeding age 4 years.

RECOMMENDATION:

I feel the Davis' are sincerely motivated in their desire to adopt a child. After my contacts with John and Debbie, I find them to be mature, well-adjusted couple with a strong desire to parent. It is my recommendation that an adopted child would greatly benefit the Davis'. It is easy to conclude that a child would be welcomed into a loving, stable family and would be given every opportunity to grow into his/her own person. Without reservation, I do not hesitate to recommend John and Debbie Davis as good prospective adoptive parents.

Signed, Dated, and Notarized

THE STATE OF UTAH} COUNTY OF __________________}

BEFORE ME, the undersigned authority on this day personally appeared __________________

who was introduced to me by original documentation to be the person whose name is subscribed to the foregoing instrument, and acknowledged to me that he/she executed the same for the purposed and consideration therein expressed.

        GIVEN UNDER MY HAND and seat of office this ____day of__________, 2010.