This  information will be used for South Carolina Adoption Reform only

1.  I support the release of the original birth certificate to an adult adoptee at age 21.

     Select One:               Yes                  No

2.  Release of non identifying information to every adoptee - regardless of which
      agency handled the adoption at age 18

       Select One              Yes                  No

Name: First Last:

Address:

City:         St:               Zip:

Email:

Phone:  Area Code   Number

I am (Please select one)  _ adoptee adopted parent birth parent birth sibling of the one that was adopted concerned citizen

If you are an adoptee, adopted parent, birthparent or member of the adopted or birth family
 Did the adoption have a connection with So Carolina ( birth, adoption, termination, adopted/birth
parent  location, etc) Yes       No

Which City & State- birth/adoption

If you are a resident of the State of SC - are you registered to vote? Yes       No

Can we count on your support for law changes in adoption records in S.C.? Yes  Not at this time

Please give us your comments: