5-Minute Express Application
*Information provided on this form is for office use only. I declare under penalty and perjury that all the answers I have given above are true and correct. ROLAA may asist birth mom with counseling services, living expenses and medical (not covered by insurance) during the course of her pregnancy. If birthmother decides not to relinquish her child for adoption, after the baby is born, ROLAA will not require repayment. Deliberate scammers will be reported.