DVAC Membership Application

Delaware Valley Adoption Council
Application for Membership

Section One: Agency/Group/Individual Information

Is your agency or Group part of a larger organization?
Section Two: CHOOSE TYPE OF MEMBERSHIP (Please complete the section that applies.)
Choose Type Of Membership
1. Sponsor Membership - Sponsor membership shall be available only to agencies and groups in Pennsylvania, New Jersey and Delaware that have an interest in adoption. An agency that is a Sponsor Member must be a provider of direct services related to adoption issues. The agency must be currently so licensed or authorized within its respective state to deliver adoption services, must have been licensed or authorized for a minimum of one year, and must support adoption as one alternative for permanency for children who cannot live with their biological families.
• State adoption licenses:
•Type(s) of adoption currently facilitated:
2. Associate Membership - Associate membership shall be available only to agencies/groups/individuals not eligible for sponsor membership, who have a purpose compatible with permanency through adoption and are engaged in the delivery of adoption-related services and/or concerned with adoption-related issues.
Service or represent families/individuals in:
Service or represent families/individuals in:
By signing I certify that all of the above information is true and accurate.  I realize that providing false or misleading information may lead to rejection or termination of membership in the DVAC as described in Article 2, Section 2.11 of the DVAC’s Bylaws.