Recruitment Form-Heart Gallery of Lane County

A Family For Every Child
Heart Gallery
541-343-2856
877-343-2856 christy@afamilyforeverychild.org

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Tax I.D. 20-4151057
Christy Obie~Barrett
Executive Director
4211 W. 11th Ave
Eugene OR 97402
fax 541-343-2866

OUR MISSION:
To find loving, permanent families for every waiting foster child.

Bulletin Photo Request & Recruitment Referral Form

Date:
*Caseworker Name
*Daytime Phone:
Alternate Phone:
*Child's Name:	Birthdate:
Child's Name (Sibling):	D.O.B.
Child's Name(Sibling)::	D.O.B.
Child's Name(Sibling)::	D.O.B.
Child's Name(Sibling)::	D.O.B.

*Case Number or Bulletin #:

*Primary Language:
*Legal Status:
Ethnicity:
*County of Residence:
*E-mail Address
*Required fields

Identifying Qualified Families-It is important to communicate on the recruitment forms , what a "succesful family" looks like for your child. We submit over 200 home studies a month and you may very well be over-loaded with families that don't fit your criteria if you don't tell us what that criteria is.

Please check each box below and fill in any information you feel is important for us to know as we screen potential families.

These child(ren) can go out of state?
Should potential family be Bi-Lingual?
*What other languages should be spoken?
*Are you looking for a one parent, two parent home? Please explain.
*Is a stay at home parent is ideal?
*Should this child be the youngest in the home
*Should other children in home be significantly older?
*Are pets are okay in the home?

*What are the child's disability levels? Please include child's name
*Additional training required? If so, please explain.
*Additional information:

*Required fields

Photolistings & Recruitment Options

Media- Please keep in mind: it is possible to recruit in only parts of the state--We are always MOST concerned about what is in the best interest of the child! For the following recruitment tools, more in-depth coordination is needed. You will be contacted when the child bulletin is released.

Please check each box you would like to utilize in your adoption recruitment for these child/children.

We are always adding to this list as we reach out to many areas

	Idaho's Child-TV/News highlight in Idaho
	Heart Gallery Child of the Week-Radio, TV and newspaper in Lane, Benton, Coos and other counties
	Eugene Wednesday's Child-KVAL TV highlight featured in Lane, Coos, Benton and Josephine counties
	Southern Oregon Wednesday's Child-TV/News highlight in Southern Oregon
	KOIN TV- highlight featured in the Portland/Salem areas

A Family For Every Child
Northwest Adoption Exchange www.nwae.org
Adopt Us Kids www.adoptuskids.org
Heart Gallery of America www.heartgalleryofamerica.org
Family Matters A bi-monthly publication with a circulation of apprx. 7,200 addresses & an additional 5,000 emails
Heart Gallery Displays Venues all around the state are updated monthly.
Please specify any areas where the child cannot be seen