Ukraine adoption dossier: petition letter

To: State Department for Adoption and Protection of Rights of the Child
vul. Desyatynna, 14
Kiev 01025, Ukraine

From: name(s) of prospective adoption parent(s)
address

We (I), the undersigned, name(s) of prospective adoption parent(s), U.S. Citizen(s), hereby request to be registered as prospective adoption parent, to be invited to the State Department for Adoption and Protection of Rights of the Child for selection of one or two children of any gender 4-10 years of age, and to be given a permission to visit an orphanage.

With this petition we (I) submit the following documents:

1. Copy of the U.S. passport

2. Medical certificate in due form and in compliance with Resolution 1377, Add. 4

3. Proof of income

4. Police clearance issued by the U.S. State competent authority

5. Favorable recommendation of prospective adoption parent issued by the U.S. State competent authority

6. The U.S. Citizenship and Immigration Services approval (Form I-171H)

7. Prospective adoptive parent commitment and post-adoption registration obligations

8. Marriage Certificate

Sincerely,
name(s) of prospective adoption parent(s),

Date