Annexure - II
Format of Monthly Report
PROFORMA FOR SUPPLYING MONTHLY DATA TO STATE ADOPTION CELL/STATE GOVERNMENT AND NEAREST ACA ABOUT DATA ON CHILDREN, NUMBER OF INDIAN ADOPTIONS, LISTS OF PAPs. REGISTERED WITH THE AGENCY.
Name & Address of the Agency :
Part (I) DATA ABOUT CHILDREN FOR THE MONTH_______________
A.
| Name, Sex and DOB of each child present in the Home | Date of Relinquishment / Abandonment. | Date of admission in the Home | *Date of Restoration/Death of the child. | Date on which the child is legally free for adoption | Health status of the child/ any special medical treatment | Remarks |
| (1) | (2) | (3) | (4) | (5) | (6) | (7) |
(Newly admitted children should also be included).
*The agency should maintain separate register for restoration and death with details
PART (II) DATA ABOUT INDIAN ADOPTIONS FOR THE MONTH___________
| Name of children, their D.O.B. and Sex who have been placed in adoption during the month | Name and address of adoptive parents / (children given to Indians) | Name, number and date of Court Order | Whether any child placed in pre -adoption foster care if yes, details thereof | Remarks |
(1) |
(2) |
(3) |
(4) |
(5) |
PART (III) LIST OF PROSPECTIVE ADOPTIVE PARENTS REGISTERED WITH THE AGENCY
| S.No. | Name and address of the Adoptive Parents | Tel No. E-Mail address | Date of Regn. | Brief Status of Home Study | Child Desired | Remarks | |||||||
| Age | Edu. Quali | No.of Childr en in the family biolo gical / adopted | Motivation to adopt | Employment status | Health status | Age | Sex | Health status | |||||