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Inter-Agency Adoption Agreement

In North Carolina, this form is to be used in drafting an inter-agency adoption agreement .Download

Extracted Text for Proper Search

North Carolina Division on Social Services 
 
 
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The purpose of this Adoption Services Inter-Agency Agreement, hereinafter referred to as the “Agreement” is to 
ensure that appropriate services are provided to all partie
s of this adoption and to facilitate communication between 
the agencies involved. 
 
This Agreement is developed between the Agency having custody of the child, hereinafter referred to as the 
“Custodial Agency”, and the Agency supervising the placement in the adoptive family, hereinafter referred to as the 
supervising Agency”. 
 
This Agreement between _____________________________________________________________________ and  
     Custodial Agency 
_________________________________________________________________________________ in reference to  
     Supervising Agency 
_________________________________________________________________________________________ and  
     Name of Prospective Adoptive Family 
____________________________________________________________________________________________ . 
     Name(s) of Child(ren) 
 
It is understood by both agencies that their respective responsibilities will be as follow: 
 
The Custodial Agency Agrees to: 
 	
1.   Provide information regarding the child(ren)’s  eligibility for adoption assistance benefits; 
 
2.   Provide all available information regarding the child(ren)’s medical, psychological, social, education and 
placement histories; 
 
3.   Provide legal clearance documents— 
o  Parent’s relinquishment and/or order terminating parental rights 
o   Agency’s Consent to Adoption 
o   Affidavit of Parentage, if applicable; and 
 
4.   Respond to problems identified by the Supervising Agency in order to develop a plan for respite, 
removal, or provision of additional supportive services to sustain placement.  Should removal be 
necessary, assume responsibility for future planning for the child(ren). 
 
The Supervising Agency Agrees to: 	
 	
1.   Have contacts with the adoptive family and child(ren) at least as often as mandated by policy.  
Document these contacts, including strengths and needs of the family and children; 
 
2.   Provide supportive services as indicated, based on the needs of the family, to include (but not limited 
to) information and referral, counseling, adjustment services, assistance with assessing services 
available through other agencies and advocacy; 
  3.  Notify the Custodial Agency of problems that may lead to the disruption of the adoptive placement and 
assist in coordinating appropriate plans;

DSS 1798 (11/2008) 
Child Welfare Services     
Page 2 of 2 
 4.  Prepare and provide reports in reference to services provided and child(ren)’s adjustment to the family.  
Submit reports to the Custodial Agency on a regular, mutually agreed upon time, but no less that 
quarterly.  Reports should include dates and details of contacts with the family and child(ren); 
 
  5.  Facilitate the legal process and provide required reports to aid in the finalization of the adoption; and  
  6.  Be available to assist family after the adoption is completed to find and utilize ongoing services as 
needed. 
 
 
Signed this __________day of _____________________________, ________  
  Day   Month   Year 
 
____________________________________________________________________________________________ . 
Signature of Director or Designee, Custodial Agency        Print Full Name  
 
____________________________________________________________________________________________ . 
Signature of Director or Designee, Supervising Agency       Print Full Name  
 
____________________________________________________________________________________________ . 
Signature of Adoptive Mother            Print Full Name  
 
____________________________________________________________________________________________ . 
Signature of Adoptive Father            Print Full Name
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