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Using the information you give us, we will describe your options, including whether the CI program would be of help to you. If not, we may be able to suggest other alternatives.

The questionnaire is designed to help you explain whom you are hoping to locate. We realize that you may have very little information — just complete the sections that you can. However, the more you tell us the better we will understand your situation. You do not have to give your name or any other identifying information. We will respond by e-mail within 5 business days. No one will call you unless you ask us to.

Our response will be based only on the information you provide by completing this questionnaire. Previous service you may have received through this agency will not be taken into consideration. If you have a current or past case with us, we suggest that you call us at 847-298-9096, ext 29 to discuss your situation more specifically.

CISI is a not-for-profit social service agency well recognized as a source of information about adoption search in Illinois.

1.	Name (optional)
2.	Email address to which reply should be sent
3.	Phone number (optional)
4.	Are you an adopted person, adoptive parent, birth parent or birth relative? Please be specific.
5.	Who are you trying to locate? Please describe the relationship but do not include the person’s name.
6.	Was the adoption completed through an adoption agency? If yes, what was the name of the agency? If you don’t have an exact name, please provide whatever you have.
7.	Were there foster placements before the adoption?
8.	Where was the adoption legally completed? Please be as specific as possible, providing the city or county and state, if possible.
9.	In what year was the child placed with the adoptive parent(s)? If you don’t know the exact year, please give approximate year.
10.	In what year was the adoption legally completed? If you don’t know the exact year, please give approximate year.
11.	What official documents or other paperwork about the placement do you have? (such as adoption decree, letters from agency or attorney, “non-identifying information”, etc)
12.	If you have information about how the adoption was arranged, or have other details that you believe to be important, please describe briefly.
13.	Briefly describe other search efforts you have made and the results.
14.	How did you find out about the CI program?
15.	Do you have a specific question or concern about how the CI program might work for you?
16.	Would you like someone from the CI program to call you? No one will contact you unless you specifically ask us to.
17.	If you answered yes to question 16, please provide phone number.

	© 2006 Midwest Adoption Center, 3158 South River Road, Suite 120, Des Plaines, Illinois 60018
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