913-381-6919 adopt@adoption-beyond.org
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Admin: Employee and Board Member Disclosure Statement and Agreement

In accordance with 22 CFR 96, Section 96.35 Hague Accreditation; Adoption & Beyond, Inc. agrees to disclose unfavorable information about its individual board members and employees.
Please complete this form and explain any answers. This form will be kept in your file at Adoption & Beyond, Inc. and will be provided to the accrediting entity and its agent(s) upon request.
Please select Yes, No or N/A and explain any Yes answers:
For the prior ten-year period, have you taken part in any conduct related to the provision of adoption-related services that was subject to external disciplinary proceeding(s)?(Required)
Have any convictions or current investigations for acts involving financial irregularities? (Applies to any individual in a senior financial management position)(Required)
Taken part in any business or activities that are inconsistent with the principles of the Convention and which is currently being carried out?(Required)
Been arrested, convicted or otherwise committed any crimes, especially related to child abuse and/or domestic violence?(Required)
Consent(Required)
MM slash DD slash YYYY
Name(Required)
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