Sample Domestic Adoption Home Study Report

NAME: Smith, Jr., Anthony "Tony" Joe and Marisa Joan (Maiden Name: Johnson)

ADDRESS: 10029 Pleasant Street, Anywhere, Kansas 66210

COUNTY: Douglas

PHONE: 913-383-9804 (home)

913-492-2229 (Work, husband) San Marcus High School

913-492-2229 (Work, wife) Tandy Elementary

DATE OF MARRIAGE: April 12, 1983 (Confirmed via marriage license #345)

CHILDREN IN HOME: Trey Smith, Born: February 14, 2001

REASON FOR HOME STUDY: Mr. and Mrs. Smith contacted The Agency for the purpose of a domestic adoption of a newborn Caucasian infant.

REFERRAL INFORMATION: They were referred to our agency by the yellow pages. They had been considering adoption for several years. They tried twice through a lawyer, but both times the birth parents chose to parent the infant rather than place for adoption.


October 9, 1996 - Telephone contact

October 12, 1996 - Couple interview in their home with Tony, Marisa, and Trey present. Home Inspection Tour completed.

October 24, 1996 - Couple interview in their home and individual interviews with Tony, Marisa, and Trey.


SOCIAL SECURITY NUMBER: 128-70-899 139-70-888
DRIVER'S LICENSE NUMBER: Kansas #BVN 333 Kansas #BVN 434
DATE OF BIRTH: 2-12-75 5-30-76
PLACE OF BIRTH: Fort Worth, TX Kalamazoo, MI
EDUCATION: BS Education BS Education
OCCUPATION: Teacher Teacher
EMPLOYER: San Marcus High San Marcus Elementary
DATE OF MARRIAGE: 4-12-99 Same
RELIGION: Baptist Baptist
AGE: 35 years 34 years
HEIGHT: 6 ft. 1 in. 5 ft. 1 in.
HAIR COLOR: Sandy Blonde Brown
EYE COLOR: Brown Blue
RACE: Caucasian Same
DECENT: English/German English/German/Cherokee
BODY STRUCTURE: Medium Bone Small Bone
COMPLEXION: Medium Medium


Marisa and Tony requested this adoption home study to facilitate their approval to become adoptive parents. The Smiths are adopting with the assistance of The Agency. Marisa and Tony wish to adopt a child from the United States. They would prefer newborn or infant and are not gender specific. They are interested in adopting as healthy a child as possible. The Smiths understand that there are no guarantees regarding the health of the child and they are willing to take that risk. (Use the exact wording regarding describing a healthy child, do not simply list that the family wants a "healthy child" No agency can guarantee a perfectly healthy child. The initial interview for this home study was completed in the Smith home with Marisa, Tony and their son Trey present. Individual interview of children school age required. If there are children in the home of this age please write a sentence here stating that individual interviews were done with these children. The Smiths report that they have never been denied approval as an adoptive home in the past. If the family reports that they have been denied approval in the past, we need to explore and document why.


Anthony "Tony" Joe Smith, Jr. was born on February 12, 1960, in Fort Worth, Texas (confirmed with birth certificate). He was the first of three children for Tony Sr. and Sue Mae Smith. His father, age 65, was a successful banker, now retired. His father's success allowed his mother, age 63, to stay home and raise their children full time. He has a sister Sheila and a brother Ronnie, 29 and 25 respectively. Sheila lives with her spouse Danny Jones and their two children, Lou Ann and Andy, in Arlington, Kansas. Sheila is an employee at Bank of America. Ronnie is obtaining a degree in Music from Texas Christian University and is currently single. They are all in excellent mental and physical health.

Tony grew up in a very family oriented environment. They all regularly attended The First Baptist Church of Fort Worth, 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.

Tony states that his father was the main disciplinarian in the Smith household. Discipline methods were time-outs and restriction of privileges. Tony states that his parents always made him feel secure. Tony plans on raising his children in a similar manner. He does not believe in spanking and will not use that form of discipline with his children.

As a child singing in the church choir, Tony, 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 Marisa in church volleyball and softball leagues. Occasionally he will play racquetball or basketball at the community center.

Tony 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 barbecue. He describes himself as an out-going, musically inclined, faithful, and caring man, who believes family is the most important thing in life.


Tony is a graduate of Texas Christian University in Fort Worth, Texas with a degree in Music Education in 1983. He graduated with honors.


Tony is a music teacher for a San Marcus high school in San Marcus, Kansas. (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.


Marisa Jane Smith was born Marisa Jane Johnson on May 30, 1961, in Kalamazoo, Michigan. She is 31 years old and the middle child of Lloyd and Marcia "Tillie" Coates. After 40 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. Marisa'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, Marisa has a brother and a sister, named Curtis and Cathy. Curtis is thirty-five and married to Fray. Curtis works as a computer consultant. Fray is a stay at home mother. They have three lovely daughters. JoAnn is 10. Cindy is eight. Marci is four. They live in Anywhere, Kansas. Cathy is 29 and is married to John Logan. John works as a pharmaceutical sales representative and Cathy is currently a stay-at-home mother. They have one son Benjamin who is three. They live in Long Beach, California.

While she was growing up, Marisa always felt special to her parents. Often typical to the middle child, Marisa never felt overlooked or unloved. Religion was important but not a dominant force in her upbringing. It was common for her father to frequently travel because of his job. Despite his time away, her father 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, Marisa still felt he greatly influenced her life. Marisa's mother always made the best out of the worst situation. It was not uncommon for her mother to make Marisa and Cathy's clothes.

Marisa was involved with numerous school activities while growing up. She was active in a group called "Rainbow" girls, which put on theatrical productions in the summer. Marisa loved theater and auditioned for all school theatrical productions. It was normal for Marisa to acquire the lead roles in most productions. Beyond theater, she enjoyed singing, sewing, knitting, watching TV, and playing softball. Marisa was a very good athlete and has found sporting activities to be one where she and Tony connect.

Discipline in Marisa's home was handled in a very loving and gentle manner. Marisa states that she does recall ever being spanked. Her parents would talk to her about her behavior and together they would come up with a suitable method of discipline. Marisa feels that her parents did an excellent job of raising her and she hopes to be a similar type parent. Marisa does not believe in spanking and plans to use similar discipline techniques to what she experienced as a child.

Marisa's family was then and still is very close. She has fond memories of her childhood. Marisa does not see her brother as much as she would like, but understands his life and that three children and a career create a very busy life. Marisa is generally closer now with her sister Cathy. They usually talk at least every two weeks.


Marisa graduated in 1984 with her bachelor's degree in elementary education from Texas Christian University in Fort Worth, Texas.


After graduating with her education degree, Marisa taught at two different elementary schools in the area. The school system moved her around, but Marisa has been employed since 1984 as a third-grade elementary teacher at Tandy Elementary in Arlington, Kansas. (Confirmed) She plans on leaving her job upon placement of a child. She plans to resume teaching once her child is old enough to start school.


Reverend Fred Swank married the Smiths April 12, 1983, at Sagamore Hills Baptist Church, in Anywhere, Kansas. (Confirmed by marriage certificate)

Tony and Marisa met while attending Texas Christian University. After only a few dates, they decided to date exclusively. Marisa states it was "love at first sight". For Tony, the love grew greater with the passing of each day. Tony wanted his feelings for Marisa to grow, but he did not want to lose sight of completing school. After graduation, he made plans to marry Marisa, although he did not let her know.

Tony began saving money and buying furniture, so when he asked for her hand in marriage he would have a future to offer her. Tony asked Marisa to help him pick out all the furniture. At the time, Marisa wondered why Tony was so concerned about her opinion.

When he did ask Marisa to marry him, they originally decided to wait for Marisa to graduate from college. Marisa's grandfather however was terminally ill and Tony and Marisa decided to marry so he could attend their wedding. Sharing their wedding with Marisa's grandfather meant a lot to both Marisa and Tony, as they loved him dearly.

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

Neither of the Smiths have previous marriages. Tony and Marisa are committed to their marriage.


Tony and Marisa have known from the beginning of their marriage that they may not be able to have biological children. Marisa suffers from fibroid tumors (benign), which prevents many women from becoming pregnant. While she was able to conceive one biological child, Trey, their doctor referred to their pregnancy as a once in a lifetime birth "miracle". Through numerous discussions, they feel certain that an adopted child would receive equal opportunities and love as their biological child. Pursuing infertility with all the physically and emotionally draining tests is not an appealing option when contrasted to that of adoption. They have attended Resolve meetings and feel they have a positive attitude of acceptance about their infertility. Their choice of adoption to expand their family has been carefully thought out and embraced by both Marisa and Tony.

Tony and Marisa would like to adopt a child from the United States They would prefer newborn or infant and are not gender specific. They are interested in adopting as healthy a child(ren) as possible. They have been communicating their personal feelings about adoption and have read books, researched on the internet, and attended lectures and workshops on adoption to help them in their decision-making.

Throughout the interviewing process Marisa and Tony spoke with enthusiasm and joy in their efforts to begin the adoption process. They are respectful of birth parents and feel they will be open in communication about adoption with their child. Family and friends are supportive of their adoption decision. They understand that adoption is a lifelong choice, and that as the years progress, they will need to continue to learn and grow with in their understanding of adoption, along with their adopted child.


The Smiths have the desire to be parents. They have openly shared their interest in closing the chapter with their fertility treatments and moving toward embracing adoption. They feel they would be blessed with the most precious gift in the world if a birth mother would select them to be the new parents. They do expect there will be an exchange of emotions between themselves and the birth parents as they interact with one another. They have both stated they will actively be a part of any type of search and reunion in the years to come. Both Tony and Marisa have related to this worker the honor and respect they already carry for their future birth parent(s) and would feel more than comfortable with sharing their views on how they will tell the child he/she was adopted and what type of relationship they shared with his/her biological parents.


Marisa and Tony do not believe in hitting or screaming at children. Marisa and Tony feel strongly that time out, consequences and positive reinforcements as behavior modification techniques work for changing unacceptable behaviors. They would discipline an older child by implementing consequences, withdrawing privileges, and setting firm yet fair limits, appropriate to the child's age and situation. They believe in disciplining without harming self-esteem. They believe in discipline without anger. They jointly share in childrearing and discipline, and provide a united parental unit. Marisa and Tony will teach their child through example, and open and honest communication. Marisa and Tony have both signed the Agency's Discipline Statement, and agree with the intent of the policy. Their signed statement will be maintained as part of their permanent file.


Tony, Marisa, and Trey are the only members of their household. Their home is tucked away on a quiet residential street located in the town of Anywhere, Kansas. They describe neighborhood as pleasantly supported with good neighbors and children of all ages. Their church and school are both within walking distance of their home. Their home is located within a reasonable distance to medical facilities, schools, and fire and police departments. There is a community pool and museum in the town.

Their home 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 Smith's home is well maintained both inside and outside and provides a safe environment for children. There are smoke detectors in all major rooms and a carbon monoxide detector on both floors of the home. The Smiths have a fire extinguisher in the kitchen. There are no firearms in the home. There is plenty of room for a growing family to flourish in this home. This worker has conducted a physical review of the home, and the checklist has been retained in their permanent file.

The Smiths own their home. They have lived at this address for the past three years. Information about their mortgage and house bills can be found in the financial section of this report.


Tony and Marisa have a large extended family and a strong network of close friends. Marisa's family is very close. Marisa has three close friends from college who provide her support. They try to have a "girl's night" for dinner together at least once a month. They were a great support to her during her infertility treatments. Two of these friends also have children and their families look forward to more times when they can socialize together.

Tony is very close with his family. He states much of his stress relief comes from his love of music. He has developed a few friends at the school where he works, and also enjoys playing on the school teacher's summer league softball team with them. When he is not playing music, gardening or participating in a sporting event, Tony enjoys playing with Trey. He has become good friends with the husbands of Marisa's college friends, and they enjoy having family BBQs all together.

Tony and Marisa also have a network of close friends through their church. They attend Sagamore Hill Baptist Church as a family and will continue this practice with any children that may be added to their family. On Sundays, Tony and Marisa sing in the church choir. Marisa is very active in the Church Missions Group. Trey has a play group he attends which is organized through the church.

On weekends it is typical for Tony to make pancakes for breakfast every Sunday before church. Marisa and Tony enjoy spending time with Trey on the weekends, and Tony likes to involve Trey with the gardening projects when possible. They feel it is important to take Trey on vacations and look forward to sharing the same experiences with their new child. They often have a family movie night on Saturday nights, and that is when Trey is allowed the treat of a Disney movie at home or at the theater.


Tony was examined on August 8, 2004 by Dr. David Dugger of Anywhere, KS. He was found to be in good mental and physical health and free of communicable diseases. Marisa was examined by her physician, Dr. Mary Cango of Anywhere, KS, on August 12, 2004. She was found to be in good mental and physical health and free of communicable diseases. The doctors support the Smiths application for adoption.


The Smiths have a gross combined annual income of $64,000. (Verified by 2005 IRS statements) Tony has an annual gross income of $32,000. Marisa has an annual gross income of $32,000 as well.

They have $201, 863 in assets. This consists of $9,000 in cash savings and checking accounts, $1,358 in life insurance cash value, $5,500 in stocks and bonds, $2,369 in a tax escrow fund, and $86,605 vested in a retirement plan through both of their employers. Their home is valued at $58,0000 and they have a thirty-year mortgage. The Smiths have $10,000 in equity in their home. They pay $383 a month on the mortgage and that includes insurance. Together with car payment, house payment, utilities, food, insurance, etc. they pay out approximately $895 per month. They have enough left over that they can well afford a child into their family.


HEALTH: They are covered with Blue Cross Blue Shield Major Medical through Tony's employer. (Verified) It covers the baby from time of placement. They must wait twelve months for pre-exiting conditions. A copy of their insurance information has been retained in their permanent file.


The Smiths are active members with a strong commitment to their church, Sagamore Hill Baptist Church. Tony's family has some religious traditions, which he wishes to continue, such as the German foods his mother prepares at Christmas time. Marisa's family celebrates some Cherokee traditions, which she states are more "spiritual" than religious. When her children are older, she looks forward to sharing these Cherokee history and stories with them.


The Smiths have a son, Anthony "Trey" Joe Smith, III who was born on February 14, 1989 after a very difficult pregnancy and an emergency c-section delivery. Anthony the III goes by the nick name Trey. Tony and Marisa liked the nickname, so they put it on his birth certificate so Trey could legally use that name. Trey has brown hair, brown eyes, and a small frame. He is in excellent health besides having numerous ear infections as a baby.

This worker found Trey's captivating personality coupled with his remarkable intelligence to make for a wonderful young man. The Smiths state that he listens and obeys his parents very well. He enjoys playing with his toy trucks and watching Sesame Street. He knows about his parents' adoption plan and understands it to the best of his developmental ability. The Smiths state that he is excited to welcome a baby brother or sister into the family.

This worker spent some time talking with Trey. Trey came across as a very intelligent and thoughtful child. He had good eye contact and appeared comfortable answering all questions. Trey states that he is very excited about his parents' plans to adopt a child. He is looking forward to being a big brother. Trey states that he thinks his parents are wonderful and they will be good parents to another child.


Two days a week, the Smiths send Trey to a day care called Little Hands. The other three days a week he stays with a licensed home based day care provider while the Smiths are teaching. During the summer, Trey stays at home with his mother. Once Marisa returns to teaching after taking leave from her job, they intend to continue with the same for future children.


In case of untimely deaths, the Smiths select Tony's sister and brother-in-law, Sheila (29 years old) and Danny (32 years old) Jones of Arlington, Kansas to be the legal guardians of their children. They feel Sheila and Danny would be wonderful parents because they currently have two lovely children. They additionally are financially secure as Danny has a career as an attorney. Sheila and Danny are both in excellent health and have spent a great deal of time with Trey. Because of their interactions with Trey, Marisa and Tony feel that the Jones' will be great parents to their children. The Smiths understand the importance of creating a legal will and are currently in the process of making one.


The Smiths have successfully handled the infertility issue of Marisa's fibroid tumors. They endured several tests and surgical techniques in their efforts to try and correct the tumors. After unsuccessful surgeries and tests, they began visiting their local Resolve group and have remained active to date. They decided against further medical intervention as they feel their primary purpose is to parent. They feel the pursuit of further infertility testing is a waste of their time and energy. The Smiths have shared their infertility and adoption plans openly with immediate family and a few close friends.


According to Tony and Marisa's self report, they have no history of abuse or violence, alcoholism, drug addiction, substance abuse, domestic violence, sexual abuse, child abuse, or criminal record. These (above) questions should be asked during the individual interviews with the applicants. If there is anyone else living in the home, 18 years of age or older, they must be asked the same questions regarding criminal history etc., as the adoptive parents and they must be written into the report using the same wording as above. Different states have different ages at which the child must start being included in the clearances. A current report on file received for the Kansas Social and Rehabilitation Services on August 10, 2002 indicates "No Probable Cause or Reason to Suspect Child Abuse/Neglect Findings" on Tony or Marisa Smith. Another current report on file from the Kansas Bureau of Investigations date August 12, 2002 also indicates "No Criminal Record" for Tony and Marisa Smith. A report from the Federal Bureau of Investigation on August 15, 2002 indicated "no record" for Tony and Marisa Smith. A review of all available records show no information that would cause Tony or Marisa to be denied approval for adoption, and indicates that Tony and Marisa are citizens in good standing within their community.

No child abuse records or criminal records through State or Federal investigations have been found. The clearance dates of each applicant are as follows:

TONY SMITH 8/11/04 8/15/02 7/10/04
MARISSA SMITH 8/11/04 8/15/02 7/10/04

Marisa and Tony stated that they have never been denied an application for a domestic or foreign adoption due to an unfavorable home study or for any other reason nor have they been rejected as prospective adoptive parents. This is Tony and Marisa's first home study.

If Marisa and Tony are arrested or convicted of any crime after the date of this report, Marisa and Tony have agreed to notify The Agency of such reports. Marisa and Tony also understand such arrests and convictions must be reviewed by The Agency and then submitted to the court handling the adoption. Marisa and Tony understand any arrests or convictions must be explained and such actions might delay or prevent their ability to adopt. Per the date of this signed and completed home study and what is listed above, The Agency has not received any additional correspondence regarding either Marisa or Tony Smith's criminal or child abuse records.


All references have been very good and supportive of the Smiths' plans to adopt. One reference said, "I fully support Marisa and Tony's desire to become parents again through adoption". Letters were obtained from four friends and their minister. They were Ed Smith of Lubbock, Kansas; Mrs. John (Brenda) Bettinger, Arlington, Kansas; Mr. and Mrs. Gary Carver, Ft. Worth, Kansas; Mrs. Jim (Sheila) Pedigo, Fort Worth, Kansas and Rev. Sammy Jones, Fort Worth, Kansas. There were no concerns whatsoever expressed in the reference letters and all letters are in agreement that the Smiths would be excellent adoptive parents. These letters have been retained as part of our permanent file. If any of the references are contacted directly, please state that "This worker personally contacted each reference person to verify the authenticity of their reference letter".


"Agency" agrees to carry out the post-placement procedures as required by the state(s) involved in the adoption. Marisa and Tony understand there are additional fees to provide post-placement services. The Smiths are aware of the importance of post-placement visits and are committed to completing the post-placement visits required by the state(s) involved in the adoption.


The Agency informs its families interested in domestic adoption about risks, delays and unknowns in domestic adoptions. Information is provided through discussion, provision of a parent preparation manual and bibliography, referral to community support groups, and information on adoption websites. Through this information, the Smiths have an understanding of general adoption issues and are aware of and accept the risks associated with domestic adoptions.

The Agency strongly advises that all families utilize the services of at least one physician in reviewing the medical information and in making their final decision on the child they wish to adopt. It is best however to seek advice from several sources to obtain a well rounded opinion.

The Smiths plan on discussing adoption with their child(ren) and will provide whatever resources necessary to support their child through difficult adoption issues. They state they realize that adoption is a lifelong process, and are committed to learning and growing in their understanding of adoption as their child grows and develops.


The Smiths 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.


The Smiths will consider a boy or girl from a newborn to a toddler. They will consider a Caucasian child, or a Caucasian/ Hispanic child, or a Hispanic child. It is possible Marisa and Tony will accept a child with mild handicaps such as clubfeet, cleft palate, etc. They however will not accept a child with known neurological or mental handicaps. They understand that it is often impossible to determine such neurological and most mental handicaps at birth. The family understands that thorough medical information may be sparse, inconclusive, or not obtainable. Medical information is sometimes not available until birth of the baby and rarely is any medical information available on the birth father. The family understands and accepts these risks.


(This section applies if adoptive family is considering adoption of a child of any race other than their own. Examples: Caucasian family adopting a Hispanic, Asian, African American etc child (other than Caucasian). Or, if a Hispanic family is adopting a Caucasian child.)


This section needs to address ways the family plans to incorporate the child's ethnicity and culture into their family and the child's environment. Examples: Does the family have close friends or other family members of the same race? Do they live in an urban area where the child will interact with others of the same race? If they live in a less culturally diverse area, how do they plan to incorporate the child's culture into their life? What literature reviews or cultural experience have they looked into or plan to research for the child?

The Smiths are excited about the possibility of a placement of a child from Hispanic or Caucasian/ Hispanic descent. They know they may receive curious looks, questions, and prejudices.

The Smiths feel very comfortable adopting a child of a different race and believe strongly that their love for each other and their family will help them with any difficulties they may encounter. They plan to be open and educate others about adoption and their adoption experience. The Smiths reside in a culturally diverse community and have several close friends of Hispanic descent who share their culture with the Smiths. They also plan to educate themselves about the specific culture, be it Mexican, Cuban etc. once they are placed with the child.


Marisa and Tony have been married for six years, with a two-year dating relationship prior to their marriage in 1990. In addition to their marriage relationship Marisa and Tony are best friends. They enjoy each other's company and share many compatible activities and future goals. Their hope and plan for the future is to become a family. Marisa and Tony would like to adopt with the help of The Agency. They would like the child or children to be as healthy as possible.

Their decision to adopt is the result of many years of unsuccessful attempts at having a biological family. Marisa and Tony are excited and comfortable with adoption as their choice of family building. Their friends and family are emotionally supportive of this decision. Marisa and Tony are financially stable and very much rooted within their community. Their home environment is conducive to raising a family. It is felt that all their child's needs would be adequately cared for.

Marisa and Tony are warm, mature and loving people with a strong moral and ethical value system. Their behaviors are congruent with their personal and spiritual beliefs. A child is very much wanted and will be very much loved by Marisa and Tony. They are sensitive to adoption issues, especially regarding domestic adoption, for birthparent(s) and for their child. They acknowledge adoption not only as a single event within their family but as an integral part of their family's ongoing life cycle. It is with much pleasure that I approve Marisa and Tony Smith be certified to adopt (one/two) child(ren).

Signed, Dated, and Notarized by Social Worker and/or Executive Director

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