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CASA Permanent Custody Report Form to the Court

  1. DO NOT USE THIS FORM !!!

    ****This form is still being tested. Anything submitted will be lost.****

  2. Insert Case JC# (from the Complaint).

  3. Case Status*

  4. Use your CASA/GAL name.

  5. Choose one*

  6. Add a 2nd CASA/GAL

  7. Choose one

  8. Enter first and last name of the child.

  9. Add a 2nd child

  10. Add a 3rd child

  11. Add a 4th Child

  12. Add a 5th Child

  13. Add a 6th Child

  14. Add a 7th Child

  15. Add an 8th Child

  16. Basis for Court Involvement:

    This is found in the caption of the Complaint.

  17. Check all that apply*

  18. File-stamped date on your JE of Appointment

  19. Prior CASA/GAL Report(s) Filed

    If you have written a prior report for this case (same case number) check "yes." Most often you will check "no."

  20. CASA/GAL has Attended all Hearings since Appointment*

    The initial emergency shelter care hearing does not count as the CASA was not yet appointed. If a CASA Staff Attorney covered a hearing for you, you must answer no.

  21. Add Missed Hearing Date 2

  22. Add Missed Hearing Date 3

  23. Add Missed Hearing Date 4

  24. Add Missed Hearing Date 5

  25. Add Missed Hearing Date 6

  26. File-stamped date on Complaint.

  27. At Emergency Shelter Care Hearing the Court awarded*

  28. Of which children?*

  29. Write full name and relationship to the child.

  30. Write full name and relationship to the child.

  31. Add Second Child

  32. Write full name and relationship to the child.

  33. Add Third Child

  34. Write full name and relationship to the child.

  35. Add Fourth Child

  36. Write full name and relationship to the child.

  37. Add Fifth Child

  38. Write full name and relationship to the child.

  39. Add Sixth Child

  40. Write full name and relationship to the child.

  41. Add Seventh Child

  42. Write full name and relationship to the child.

  43. Add Eighth Child

  44. Write full name and relationship to the child.

  45. Documents Reviewed Since Last GAL Report:

  46. Add Document 2

  47. Add Document 3

  48. Add Document 4

  49. Add Document 5

  50. Add Document 6

  51. Add Document 7

  52. Add Document 8

  53. Add Document 9

  54. Add Document 10

  55. Placement History:

  56. Type "All Children" if all of the children were moved to the same home at the same time.

  57. Add Placement 2

  58. Type "All Children" if all of the children were moved to the same home at the same time.

  59. Add Placement 3

  60. Type "All Children" if all of the children were moved to the same home at the same time.

  61. Add Placement 4

  62. Type "All Children" if all of the children were moved to the same home at the same time.

  63. Add Placement 5

  64. Type "All Children" if all of the children were moved to the same home at the same time.

  65. Add Placement 6

  66. Type "All Children" if all of the children were moved to the same home at the same time.

  67. Add Another Placement 7

  68. Type "All Children" if all of the children were moved to the same home at the same time.

  69. Add Another Placement 8

  70. Type "All Children" if all of the children were moved to the same home at the same time.

  71. Add Another Placement 9

  72. Type "All Children" if all of the children were moved to the same home at the same time.

  73. Add Another Placement 10

  74. Type "All Children" if all of the children were moved to the same home at the same time.

  75. Add Another Placement 11

  76. Type "All Children" if all of the children were moved to the same home at the same time.

  77. Add Another Placement 12

  78. Type "All Children" if all of the children were moved to the same home at the same time.

  79. Add Another Placement 13

  80. Type "All Children" if all of the children were moved to the same home at the same time.

  81. Add Another Placement 14

  82. Type "All Children" if all of the children were moved to the same home at the same time.

  83. Add Another Placement 15

  84. Type "All Children" if all of the children were moved to the same home at the same time.

  85. Persons Interviewed:

    List all the people you have interviewed and their relationship to the child(ren) involved on the case. Be sure to include CASA children interviewed or observed.

  86. Add Person Interviewed 2

  87. Add Person Interviewed 3

  88. Add Person Interviewed 4

  89. Add Person Interviewed 5

  90. Add Person Interviewed 6

  91. Add Person Interviewed 7

  92. Add Person Interviewed 8

  93. Add Person Interviewed 9

  94. Add Person Interviewed 10

  95. Add Person Interviewed 11

  96. Add Person Interviewed 12

  97. Add Person Interviewed 13

  98. Add Person Interviewed 14

  99. Add Person Interviewed 15

  100. Add Person Interviewed 16

  101. Add Person Interviewed 17

  102. Add Person Interviewed 18

  103. Add Person Interviewed 19

  104. Add Person Interviewed 20

  105. Add Person Interviewed 21

  106. Add Person Interviewed 22

  107. Add Person Interviewed 23

  108. Add Person Interviewed 24

  109. Add Person Interviewed 25

  110. Attempted Contacts - Unsuccessful:

    List any parties you have tried unsuccessfully to interview and put in your attempts to reach these parties.

  111. Add Attempted Contacts - Unsuccessful 2

  112. Add Attempted Contacts - Unsuccessful 3

  113. Add Attempted Contacts - Unsuccessful 4

  114. Add Attempted Contacts - Unsuccessful 5

  115. Add Attempted Contacts - Unsuccessful 6

  116. Add Attempted Contacts - Unsuccessful 7

  117. Add Attempted Contacts - Unsuccessful 8

  118. Add Attempted Contacts - Unsuccessful 9

  119. Add Attempted Contacts - Unsuccessful 10

  120. Add Attempted Contacts - Unsuccessful 11

  121. Add Attempted Contacts - Unsuccessful 12

  122. Add Attempted Contacts - Unsuccessful 13

  123. Add Attempted Contacts - Unsuccessful 14

  124. Add Attempted Contacts - Unsuccessful 15

  125. Dates of Contact with Child:

  126. Type "All Children" if you saw all of the children at the same time.

  127. Add Date of Contact 2

  128. Add Date of Contact 3

  129. Add Date of Contact 4

  130. Add Date of Contact 5

  131. Add Date of Contact 6

  132. Add Date of Contact 7

  133. Add Date of Contact 8

  134. Add Date of Contact 9

  135. Add Date of Contact 10

  136. Add Date of Contact 11

  137. Add Date of Contact 12

  138. Add Date of Contact 13

  139. Add Date of Contact 14

  140. Add Date of Contact 15

  141. Add Date of Contact 16

  142. Add Date of Contact 17

  143. Add Date of Contact 18

  144. Add Date of Contact 19

  145. Add Date of Contact 20

  146. Add Date of Contact 21

  147. Add Date of Contact 22

  148. Add Date of Contact 23

  149. Add Date of Contact 24

  150. Add Date of Contact 25

  151. Add Date of Contact 26

  152. Add Date of Contact 27

  153. Add Date of Contact 28

  154. Add Date of Contact 29

  155. Add Date of Contact 30

  156. Add Date of Contact 31

  157. Add Date of Contact 32

  158. Add Date of Contact 33

  159. Add Date of Contact 34

  160. Add Date of Contact 35

  161. Add Date of Contact 36

  162. Add Date of Contact 37

  163. Add Date of Contact 38

  164. Add Date of Contact 39

  165. Add Date of Contact 40

  166. Add Date of Contact 41

  167. Add Date of Contact 42

  168. Add Date of Contact 43

  169. Add Date of Contact 44

  170. Add Date of Contact 45

  171. Add Date of Contact 46

  172. Add Date of Contact 47

  173. Add Date of Contact 48

  174. Add Date of Contact 49

  175. Add Date of Contact 50

  176. Add Date of Contact 51

  177. Add Date of Contact 52

  178. Add Date of Contact 53

  179. Add Date of Contact 54

  180. Add Date of Contact 55

  181. Child(ren)'s Well Being:

    Write in complete sentences in the comment section.

  182. Physical Health*

  183. Are Children on Target Developmentally?*

  184. Mental Health*

  185. Process*

    Do the children understand the situation?

  186. Safety*

    Do the children feel safe in their current environment?

  187. Financial Needs or Special Financial Circumstances*

  188. Are Children Visiting Parents, Siblings and Appropriate Relatives?*

  189. Has LCCS Arranged Case Plan Services?*

  190. Are Parties in Compliance with Court Orders?*

  191. This is a fact-based narrative section. Describe where each child is living and how each child is doing (positive and negative) in that placement. Describe the basic elements of the case plan (services). Describe parental and children's progress (or lack thereof) on case plan services. Is the Agency (LCCS) compliant with the goals of the case plan? Do not include a Case History or Recommendations and please do not repeat information.

  192. School Status:

    Include each child, whether they are in school or not.

  193. School Type*

  194. Is the child age appropriate for the grade?

  195. Did the school change after removal?

  196. If in high school, is the teen on target toward graduation?

  197. Since removal, grades have:

  198. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  199. Add Child School Status 2

  200. School Type 2

  201. Is the child age appropriate for the grade? 2

  202. Did the school change after removal? 2

  203. If in high school, is the teen on target toward graduation? 2

  204. Since removal, grades have: 2

  205. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  206. Add Child School Status 3

  207. School Type 3

  208. Is the child age appropriate for the grade? 3

  209. Did the school change after removal? 3

  210. If in high school, is the teen on target toward graduation? 3

  211. Since removal, grades have: 3

  212. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  213. Add Child School Status 4

  214. School Type 4

  215. Is the child age appropriate for the grade? 4

  216. Did the school change after removal? 4

  217. If in high school, is the teen on target toward graduation? 4

  218. Since removal, grades have: 4

  219. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  220. Add Child School Status 5

  221. School Type 5

  222. Is the child age appropriate for the grade? 5

  223. Did the school change after removal? 5

  224. If in high school, is the teen on target toward graduation? 5

  225. Since removal, grades have: 5

  226. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  227. Add Child School Status 6

  228. School Type 6

  229. Is the child age appropriate for the grade?

  230. Did the school change after removal? 6

  231. If in high school, is the teen on target toward graduation? 6

  232. Since removal, grades have: 6

  233. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  234. Add Child School Status 7

  235. School Type 7

  236. Is the child age appropriate for the grade? 7

  237. Did the school change after removal? 7

  238. If in high school, is the teen on target toward graduation? 7

  239. Since removal, grades have: 7

  240. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  241. Add Child School Status 8

  242. School Type 8

  243. Is the child age appropriate for the grade? 8

  244. Did the school change after removal? 8

  245. If in high school, is the teen on target toward graduation? 8

  246. Since removal, grades have: 8

  247. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  248. You must ask each child on your case, individually and in private, what the child wants regarding placement and permanence. The child's wishes may be different than your recommendations, but his or her wishes, as stated to you, must be reported in this section. You may quote the child. Example: "Johnny stated to me, 'I want to live with Mommy if her boyfriend moves out.'"

  249. State or list any strengths evident in the biological family from which the child was removed.

  250. Briefly list any specific concerns. This is not a place to put your recommendations, only your concerns not mentioned before in this report.

  251. Number each recommendation. Write each recommendation on its own separate line. Custody must be addressed as the first recommendation.

  252. In addition, the CASA/GAL requests the Court restrict access and place this report under seal to preserve the privacy, confidentiality, and safety of the parties and the best interests of the child(ren).

  253. REMINDER: Email individual photos of each child to the CASA office identifying what each child is wearing so we know which child belongs to which picture.

  254. By checking this box, I attest that I am the aforementioned CASA/GAL and this report is my work product.*

  255. Leave This Blank:

  256. This field is not part of the form submission.