Advanced Search

Free GUARDIANSHIP QUESTIONNAIRE.PDF - California



Download Download File ( 13.2 kB)
Excerpt: PROBATE COURT GUARDIANSHIP QUESTIONNAIRE SEPARATE QUESTIONNAIRE NEEDED FOR EACH PROPOSED GUARDIAN (If further explanation is needed on any item, please use back of page.) CASE #___________________________ HEARING DATE____________________________ NAME OF CHILD:_______________________________________ DOB:_____________________ CHILD'S ADDRESS________________________________ SCHOOL_______________________ NAME OF PROPOSED GUARDIAN:___________________________________________________ RELATIONSHIP TO CHILD__________________________________________________________ OTHER NAMES USED INCLUDING MAIDEN (BIRTH) NAME:______________________________ Age________ Date of Birth______________ Place of Birth________________________________ Address___________________________ City_______________ State________ Zip___________ Home Phone_________________________ Busines
PROBATE COURT GUARDIANSHIP QUESTIONNAIRE SEPARATE QUESTIONNAIRE NEEDED FOR EACH PROPOSED GUARDIAN (If further explanation is needed on any item, please use back of page.) CASE #___________________________ HEARING DATE____________________________

NAME OF CHILD:_______________________________________ DOB:_____________________ CHILD'S ADDRESS________________________________ SCHOOL_______________________ NAME OF PROPOSED GUARDIAN:___________________________________________________ RELATIONSHIP TO CHILD__________________________________________________________ OTHER NAMES USED INCLUDING MAIDEN (BIRTH) NAME:______________________________ Age________ Date of Birth______________ Place of Birth________________________________ Address___________________________ City_______________ State________ Zip___________ Home Phone_________________________ Business Phone______________________________ Sex__________ Height__________ Weight___________ Eyes___________ Hair___________ Driver's License/I.D. No.___________________ Social Security No._________________________ NATURAL MOTHER OF CHILD Name____________________________________________________________________________ Address:_________________________________________________________________________ (if unknown, last known address) City____________________ State__________ Zip____________ Phone___________________ Height_____________ Weight_____________ Eyes_______________ Hair_________________ Driver's License/I.D. No.______________________ Social Security No.______________________ Date of Birth:____________________ Place of Birth:_____________________________________ NATURAL FATHER OF CHILD Name____________________________________________________________________________ Address:_________________________________________________________________________ (if unknown, last known address) City____________________ State__________ Zip____________ Phone___________________ Height_____________ Weight_____________ Eyes_______________ Hair_________________ Driver's License/I.D. No._____________________ Social Security No._______________________ Date of Birth:____________________ Place of Birth:_____________________________________

-1-

OTHER CHILDREN OF MOTHER OR FATHER OF PROPOSED WARD: Name Age DOB Address (with whom)? ____________________________ _____ _________ __________________________________ ____________________________ _____ _________ __________________________________ ____________________________ _____ _________ __________________________________ EMPLOYMENT DATA OF PROPOSED GUARDIAN Occupation_______________________________________________________ Monthly Income (salary, commission, etc.)_________________________________________ If unemployed, what are your employment plans?_________________________________________ Present or Last Employer_______________________ Address______________________________ Work Days & Hours___________________ Employment Began____________ Ended___________ Type of Work______________________________________________________ Gross Monthly Income (all sources, excluding support)_____________________________________ Monthly Expenses_____________________________ Previous emplo yer_____________________________ Address_____________________________ Employment Began____________________ Ended_______________________ Reason Ended_____________________________________________________________________ Bank________________________________ Branch______________________________________ ( ) Checking Acct.#______________________ ( ) Savings Acct.#_________________________ MARITAL HISTORY OF PROPOSED GUARDIAN List All Marriages Name Date & Place 1. ____________________ 2. ____________________ 3. ____________________ ____________ ____________ ____________

How Terminated _______________ _______________ _______________

Date Separated ______________ ______________ ______________

Final ____ ____ ____

Proposed Guardian's children (include adult children, first & last names) Names (list all) ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ Age ____ ____ ____ ____ ____ ____ DOB ______ ______ ______ ______ ______ ______ Children's address _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ School (if going) _________________ _________________ _________________ _________________ _________________ _________________

-2-

PROFESSIONAL PRACTITIONERS: (medical doctors, psychiatrists, psychologists, marriage counselors, social workers, etc.) Name & Title Last Contact Address (+ zip) ___________________________ ___________________________ EDUCATION __________ __________ _______________________ _______________________

Phone __________ __________

High School Graduate? ________________ If not, grade last attended_______________________ Place & Name of High School______________________________________ Age left school______ Reason________________________________________________________ List College or University Attended: ______________________________________________ HEALTH Insurance_________________________________________________________________________ Present Health Status: Good______________ Fair_____________ Poor_____________ Degree or Units/Majors _______________________________

If Fair or Poor, Explain_______________________________________________________________ Are you taking any medications? Yes____________ No______________

If yes, what kind and for what reasons? ________________________________________________ Special Health Problems:____________________________________________________________ Have you ever had a problem with any of the following: Alcohol--Yes________ No_________ Mental/Emotional Problems--Yes________ No________ CRIMINAL RECORD Have charges ever been filed against you for any crime other than traffic citations? Yes_______ No________ List Arrests: 1.________________________ 2.________________________ If yes, please specify: Where ________________ ________________ When __________________ __________________ Charge ____________ ____________ Drugs--Yes________ No________

Are you on Probation now?____________ Are you on Parole now?______________

Officer's Name____________________________ Agent's Name____________________________

-3-

HOUSING Rent_________ Own_________ Buying_________ Amount Per Month__________________ Is it a House?________ Or Apt.________

How Many Bedrooms/Baths_____________________

Do you plan to remain in this residence, or are you looking for another location?_________________ List your residences for the past three years: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

PLANS FOR CHILD CARE IF NEEDED: (If more space is needed, use the back.) 1. If child care provider is licensed: Name:________________________________________________________________________ Address:______________________________________________________________________ Phone:_____________________________

2. If child care provider is unlicensed: a. Name:____________________________ Address___________________________________ Date of birth:_______________________ Social Security No.:__________________________ Phone:______________________ Relationship to child:______________________________

b. Name:____________________________ Address___________________________________ Date of birth:_______________________ Social Security No.:__________________________ Phone:______________________ Relationship to child:______________________________

c. Name:____________________________ Address___________________________________ Date of birth:_______________________ Social Security No.:__________________________ Phone:______________________ Relationship to child:______________________________

-4-

HOUSEHOLD COMPOSITION Please list ALL other adults and children in the home, including your adult children. (If more space is needed, use back of page.) NAME________________________________________ Other Names Used (incl. Maiden/Birth Name)____________________________________________ Age_________ Date of Birth___________________ Place of Birth_________________________

Employer_____________________________ Address____________________________________ Monthly Income________________________ Business Phone________________________ Sex__________ Height__________ Weight___________ Eyes___________ Hair___________ Driver's License/I.D. No.___________________ Social Security No._________________________ Relationship to Guardian____________________ Relationship to Child_______________________

NAME________________________________________ Other Names Used (incl. Maiden/Birth Name)____________________________________________ Age_________ Date of Birth___________________ Place of Birth_________________________

Employer_____________________________ Address____________________________________ Monthly Income________________________ Business Phone________________________ Sex__________ Height__________ Weight___________ Eyes___________ Hair___________ Driver's License/I.D. No.___________________ Social Security No._________________________ Relationship to Guardian____________________ Relationship to Child_______________________

NAME________________________________________ Other Names Used (incl. Maiden/Birth Name)____________________________________________ Age_________ Date of Birth___________________ Place of Birth_________________________

Employer_____________________________ Address____________________________________ Monthly Income________________________ Business Phone________________________ Sex__________ Height__________ Weight___________ Eyes___________ Hair___________ Driver's License/I.D. No.___________________ Social Security No._________________________ Relationship to Guardian____________________ Relationship to Child_______________________

-5-

SUMMARY OF VIEWS

Please summarize your views and concerns as clearly as possible on the following pages. If additional space is needed, use the back of the page and refer to the question number. 1. Why are you seeking guardianship of the child?

2. If the child lives with you, when did you get custody and how? Do the child's parents agree with the guardianship?

3. Is there anyone who opposes your guardianship? Explain.

-6-

4. How do you plan to care for the needs of the child with regard to housing, finances, schooling, child care and supervision, discipline and guidance?

5. Does the child have any special problems? How are you qualified to help with these problems?

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

______________________________________ Signature

____________________________ Date

-7-

File Size: 13.2 kB
Pages: 7
File Format: PDF
State: California
Category: Court Forms - Local
Author: ewhite
Word Count: 790 Words, 10,980 Characters
Page Size: Letter (8 1/2" x 11")
Embed
URL

http://www.fresnosuperiorcourt.org/_pdfs/guardianship_questionnaire.pdf