Adoption Assistance Reimbursement Claim Form

Stanford University offers eligible employees adoption assistance that reimburses up to $10,000 per adoption for "qualified adoption expenses." Any expenses incurred on or after the employee's first day of Stanford University employment, but not before September 1, 2001, are eligible for reimbursement consideration.

The adopted child must:
  • Be under the age of 18 at the time a "qualified adoption expense"* is paid or incurred and
  • Not be the child of the employee's spouse, domestic partner or committed partner.

    * indicates required fields.

    Stanford University Employee’s Name: *





    Spouse/Partner's Name:




    Dependent & Expense Information

    From your Stanford Email Account, compose a message with "Secure:" at the start of the email subject line and address to WorkLifeFinAssist@stanford.edu.

    Items to include:
    - Your Employee ID - The child's full name
    - The child's age
    - Date child was placed in the home
    - Date adoption was finalized
    - A copy of the executed adoption contract or agency agreement
    - Receipts from the agency, lawyer or party that assisted with carrying out the adoption
    - A copy of the court order and/or adoption contract that confirms the finalization of the adoption or the child's placement in your home


    I certify that I have attached all applicable documentation for reimbursement under Stanford University’s Adoption Assistance Program. I understand I must notify the WorkLife Office of any change regarding the adoption. I certify under penalty of perjury that all statements and documentation relating to this claim are complete and true. I understand that incomplete or inaccurate information may adversely affect my eligibility under this program up to and including repayment to Stanford University of any funds awarded, and/or may result in adverse employment consequences for myself. *

    Connecting with Others: Are you interested in potentially sharing your adoption experience/insights with other faculty and staff members who are starting the adoption process? *

    Additional Information

    If you have any questions, please email WorkLifeFinAssist@stanford.edu for additional support.