Private Adoption Placement – A private adoption referral packet must contain the

Private Adoption Placement – A private adoption referral packet must contain the following documents: 1. A completed ICPC-100A; 2. A copy of the Sending Agency’s license or certification; 3. A cover letter on Agency letterhead containing the name of the child, the birth parent(s), and the prospective adoptive parent(s); a. The letter must explain how the child was matched with the prospective adoptive parent(s) and identify the name and address of the person or entity providing post-placement supervision. 4. Either an order showing termination of parental rights or a voluntary relinquishment of rights that was accepted by a court for both the mother and the father, or a copy of the signed consent(s) to relinquish parental rights and a legal risk placement agreement signed by the prospective adoptive parent(s); 5. A certification by a licensed attorney or authorized agent of the private adoption agency that the relinquishments of parental rights comply with the applicable laws of the Sending State or, where applicable, the Receiving State; a. If the Receiving State laws are applied, the packet must contain a waiver of the Sending State’s laws governing relinquishment of parental rights signed by the birth parent(s). 6. Verification of compliance with ICWA; 7. A current case history, if applicable; 8. Information about the child’s history and current needs and abilities; a. If the child is an infant, the packet must contain birth/medical records and a hospital discharge summary. 9. Background information or a social/medical form on the birth parents; 10. A statement indicating why the child is being placed for adoption; 11. Affidavit regarding counseling of the birth parent(s); a. Counseling must be conducted by a licensed social worker affiliated with a licensed child placing adoption agency. 12. A current adoption home study completed by a licensed social worker affiliated with a licensed child placing adoption agency; a. If the home study is more than a year old, the packet must contain an update. b. Must contain a criminal and child abuse background check. 13. An affidavit of expenses charged to the adoptive parent(s); 14. A statement of fees/expenses paid to the birth parent(s); 15. A written statement from the person/entity that will provide post-placement supervision (this may be included in the home study); 16. A statement giving the prospective adoptive parent(s) authority to provide medical care to the child; 17. A statement explaining what will happen to the child if the adoptive placement disrupts; and 18. A prepaid Federal Express envelope. An original referral packet and two (2) copies must be sent to the ICPC Unit via Federal Express.