ࡱ> \_[ @ %;bjbj f) lllllll   8]LN],j@ H!!!!y"N"4"(E+E+E+E+E+E+$j-R/i+Ql#y"y"##i+ll!!+$$$#(l!l!($#($$ll$!] p%J3 ?#@$w%+0,$B0# B0$llllB0l$##$#####i+i+ D $DPERSONAL REFERENCE LETTERMichigan Department of Human ServicesDear FORMTEXT      :Our agency is responsible for placing children for adoption with families. FORMTEXT      has/have applied to adopt a child/children and we wish to give him/her/them careful consideration. Please help us by answering some brief questions and returning this form in the enclosed envelope to the adoption worker listed at the end of this form.What is your relationship to the applicant(s) (e.g. neighbor, employer, friend, teacher, etc.)? How long and how well have you known him/her/them?  FORMTEXT      What observations have you made as to the person(s) ability to parent a child? FORMTEXT      Do you have any concerns about their ability to care for a child? If so, please explain: FORMTEXT      How does /he/she/they get along with people? (family members, people in the community, etc.) FORMTEXT      Would you recommend him/her/them as an adoptive parent(s)? Why or Why not? FORMTEXT      Additional comments or concerns. FORMTEXT      Signature of Person Giving ReferenceDateAddress FORMTEXT      CityStateZip Code FORMTEXT       FORMTEXT       FORMTEXT      Day Time Telephone Number (Include Area Code)Home Telephone Number FORMTEXT       FORMTEXT      Thank you fo8:^ ` t v x X Y c d tvˡˡ|ˡjfh!pUj0h!pUjh!pUh!pjh!pUhDh@OJQJh@OJQJjhUjh:UmHnHujlhUjhU h(36h h5hh(3608:sj $Ifgd(36<kd^$$Ifl4y,y,4 lalf4 $Ifgd!p<kd$$Ifl4y,y,4 lalf4 $Ifgd(36:;;B_|pgWd8$If^gd $Ifgd d8$Ifgd<kd$$Ifl4y,y,4 lalf4 $Ifgd(,<kd$$Ifl4y,y,4 lalf4^ OF= $Ifgdu6 $Ifgdu6<kdx$$Ifl4 y,y,4 lalf4dL$If^gdVq+bkd$$Ifl4 Fy,@ i    4 lalf4 bY $Ifgdw<kd$$Ifl4y,y,4 lalf4d8$If^gdDOkdJ$$Ifl40y,4 lalf4 W X   |s6<kdd$$Ifl40y,y,4 lalf4 $Ifgd(36<kd$$Ifl4y,y,4 lalf4 $Ifgd(36<kd$$$Ifl4y,y,4 lalf4 |s6<kd$$Ifl4y,y,4 lalf4 $Ifgd(36<kd$$Ifl4y,y,4 lalf4 $Ifgd(36<kd$$Ifl4y,y,4 lalf4 rt4|s6<kd $$Ifl4py,y,4 lalf4 $Ifgd(36<kd6$$Ifl4y,y,4 lalf4 $Ifgd(36<kd$$Ifl4y,y,4 lalf4v68LNPZ\*,>@TVXbdײתן۪תה۪ת׉۪ת~۪j!hUjhUjChUj hUjhUh5CJ KH \^JaJ j h!pUj h!pUhjh:UmHnHujh!pUjh!pUh!p146^`|s6<kd $$Ifl4y,y,4 lalf4 $Ifgdu6<kdF $$Ifl4py,y,4 lalf4 $Ifgd(36<kdv $$Ifl4y,y,4 lalf4&|<kd $$Ifl4Py,y,4 lalf4 $Ifgd(,<kd| $$Ifl4py,y,4 lalf4&(*,<i` $Ifgd(,<kd $$Ifl4Py,y,4 lalf4 $IfgdDOkdH $$Ifl40%y,%4 lalf4<>fhr~|sss $Ifgd(\<kd*$$Ifl4y,y,4 lalf4 $Ifgdw<kdZ $$Ifl4y,y,4 lalf4  $Ifgd(\skd$$Ifl4F<Z!y,<      4 lalf4p  666666666666 77777~7777777777777774;6;8; hwhhB:h^JaJjhUj6hUjhUjthU hCJUj.hUjh:UmHnHujhUjhU h5h4  h3OkdH$$Ifl40<y,<=4 lalf4 $Ifgdwskd$$Ifl4F<Z!y,<      4 lalf4p&6(6`6z66]TTT $Ifgd(\<kd$$Ifl4Py,y,4 lalf4 $$Ifa$gdOkd$$Ifl40<y,<=4 lalf4 $Ifgdwr your assistance,Adoption Worker s SignaturePrinted NameDateAgency Name FORMTEXT      Agency Address FORMTEXT      Adoption Worker s Telephone NumberFax Number FORMTEXT       FORMTEXT      Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. 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