Home Evaluation Report for AdoptionReport submitted by Home Evaluators about a potential adoption family.Step 1 of 5 - Applicant Information20%Applicant InformationApplicant Name(Required) First Last Age(Required)Please enter a number from 1 to 99.Co-Applicant Name First Last AgePlease enter a number from 1 to 99.Address(Required) Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Date of Visit(Required) Month Day Year Adoption Application Date(Required) Month Day Year Name of Evaluator(Required) First Last Phone(Required)Email(Required) Next - Exterior CommentsHome ExteriorStyle of Home 1-Story 2-Story Townhouse Apartment OtherHome Style Comments Entry StairsPlease enter a number from 0 to 50.How many stairs to enter the home?Home Well Cared For? Yes NoIs the home well cared for?Cared For Comments TrafficDescribe amount of traffic near the home.Yard Well Kept? Yes NoIs the yard well-kept?Yard CommentsType of Fence Physical Electric No FenceWhat type of fence surrounds the yard?Fence Height N/A 3-4 feet 5-6 feet Over 6 feetWhat is the fence height?Can the dog escape?Are there areas where a Golden could escape?Safety and Exercise Plan?How will the family ensure safety and exercise?Safety Concerns?Are there safety concerns in the yard or garage area?Water Hazards?Is there a body of water or a pool on, or adjacent to, the lot?Overall comfort with yardHow comfortable would you be if your dog accessed this yard unsupervised? Previous - Applicant Information Next - Interior CommentsHome InteriorIs the home well kept?Type of flooringDescribe the type of flooring in this house.Stairs in the homeHow many stairs are in the home?Where is the dog when no one is home?Where will the dog spend its time when the family is not home?Out of town plan?Where will they keep the dog when they go out of town?Where will the dog sleep at night?How long alone?How long will the dog stay alone each day?Interior SafetyAre there any safety concerns regarding the interior of the home? Previous - Exterior Comments Next - InteractionsInteractionsHow did they react to your dog?If your Golden attended, how did the applicants greet you and your Golden?Children interactionList any children's names and ages. Does it appear children have experience with dogs? How did the children interact with your Golden?Other petsList any other pets and their ages. Do other pets appear well-cared for? How did they interact with you and your golden? How does the family interact with their family pet? Is the animal well behaved? What type of food do they feed their dog? Do they take their pet for regular vet visits?Other pet visitorsDo other family members who live outside the home regularly visit? Do they bring their pets?Why a rescue dog?Why does the family want to adopt a rescued golden vs. purchasing one from a breeder?Experience with dogs? Yes NoDoes the family appear to have experience with dogs?Take obedience classes? Yes NoAre they willing to take an obedience class if the Foster Home recommends it?Type to adoptDescribe the type of Golden they hope to adopt. (Age, Size, Energy Level, Sex)Foster to Adopt Yes No UnsureWould they consider a foster-to-adopt situation?Non-traits for adoptionDescribe any traits they are NOT looking for in a Golden?Can they care for your dog?Would you feel comfortable having the family care for your Golden? Explain.Overall interaction commentsAny additional comments on subjects not covered above that are relevant to this potential adopter that SEVA GRREAT should be made aware of for consideration. Previous - Interior Comments Next - Overall RecommendationOverall impressions(Required)What was your overall impression of the family?Recommend to adopt?(Required) Yes NoDo you feel this family should be approved?CAPTCHAPrevious - Interactions Submit If you have any additional questions regarding adopting.Please contact our adoption coordinator at firstname.lastname@example.org.