Free Custody Evaluation Report - Hawaii

Name:______________________________________ Address:___________________________

___________________________
Telephone No.:_______________________

CUSTODY EVALUATOR

IN THE FAMILY COURT OF THE FIRST CIRCUIT STATE OF HAWAI`I ) ) _______________________________, ) Plaintiff/Petitioner, ) ) vs. ) ) _______________________________, ) Defendant/Respondent. ) ) FC-____ No. _______________________ CUSTODY EVALUATION REPORT

Hearing Date/Time:___________________ Presiding Judge:_____________________

CUSTODY EVALUATION REPORT
Custody Evaluator: CE's Address/Phone/Fax/Email:

Date of Report:

Mother:

Father:

Mother's Attorney:

Father's Attorney:

Other Adults Evaluated and Relationship to the Child/ren:

Appendix 6 Effective 09/07
Reprographics (10/07)1F 1F-P-737

List the Child/ren (start from oldest), date of birth, age, school, grade:

Summary of Conclusions (conclusions should be supported by facts found in this report with the relevant report page numbers cited) (Reminder: Please sign and date your report on the last page of the report ) A. Child/ren's Special Needs: B. Each parent's/caretaker's ability to meet these needs: C. Suggested Custody Arrangements (legal and physical): D. Suggested Parenting Plan: E. Other special considerations (must include the special issues noted in the Appointment Order): Table of Contents of this Report (All of the following topics must be included in the order noted below; type in the relevant page numbers; the CE is free to add other necessary topics. Topic I. II. III. IV. Page

Current Custody and Visitation Schedule for Each Child ........................ ____ Current Living Arrangements for Each Child in Each Home ..................... ____ Parenting Arrangements Prior to Separation ......................................... ____ The Child/ren's Special Needs (developmental, emotional, physical, cognitive, religious, cultural) and the Child/ren's Hopes/Opinions............... ____
1F-P-737

Reprographics (10/07)1F

Topic (continued) V.

Page

Each Parent's/Caretaker's Attachment and Ability to provide for Each Child's Needs.................................................................................. ____ (including, but not limited to, parenting skills, impairments, availability, willingness to facilitate the child/ren's relationship with other parent/caretaker, willingness and ability to communicate regarding the child/ren, unique manner in which each parent's skills fit the child/ren's needs and parent's perception of the strengths and weaknesses of the other parent's parenting abilities). A. B. C. D. E. Mother Father Stepparent/Caretaker in Mother's Household Stepparent/Caretaker in Father's Household Other Significant Caretakers

VI.

Custody Arrangements (legal and physical) ......................................... ____ A. B. C. Arrangements Suggested by Each Parent Various Arrangements Considered by the CE CE's Suggested Arrangement

VII.

Parenting Plan/Visitation--"Time Share" Arrangements .......................... ____ A. B. CE's Evaluation of Plans/Arrangements Suggested by the Parents CE's Suggested Parenting Plan

VIII. IX.

The Focus Issues Listed in the Appointment Order ................................ ____ Other Special Considerations ............................................................. ____ (for example, if domestic violence is found and the CE suggests any sort of custody to or unsupervised visits with the perpetrator, please explain) CE's Procedures ............................................................................ ____ A. B. C. D. E. Interviews of Child/ren, Parents, and Significant Adults (list names and relationship to child/ren, dates and length of each interview) Home Visits and Other Observations (list place, dates, length of each observation) Assessments, Evaluations, Testing (type of procedure, date, by whom, cost, summary of conclusions) Collateral Contacts (identify contact, date, reason for contact) Documents and Other Material Reviewed

X.

XI.

CE's Fees and Costs ........................................................................ ____ (list total itemized fees, total itemized costs, payments already paid and by whom)
1F-P-737

Reprographics (10/07)1F

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CLEAR