Free Microsoft Word - CE Rev Memo Appendix 7 Annual Trg Cert 06-07.doc - Hawaii

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Date: June 22, 2007
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Custody Evaluator's Annual Training Certification
For Calendar Year: _______ Date Submitted: __________________
(submit by January 31st )

I, __________________________________, wish to continue to serve as a court appointed custody evaluator. My current contact information: Address: ______________________________________________________________ Phone No. _______________ Cell No. _______________ Fax No. ________________ E-mail Address: ________________________________________________________ I am licensed to practice in the field of_____________________________ in the State of Hawai'i. My license expires on __________________________. During the past year to date, the following complaints/criminal charges were filed/lodged against me (please list disposition, if any): _________________________ ______________________________________________________________________ I have received ________ appointment orders and I have performed the

following pro bono services as a custody evaluator in the past calendar year: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ I have taken the following specialized training this past calendar year (list name of course, date, sponsoring organization, whether and how many continuing education credits were earned--for a course or program outside the purview of the CE's profession and the Family Law Section's annual program, note the date of CIU's approval): Course #1: ____________________________________________________________ _____________________________________________________________________ Course #2: ____________________________________________________________ _____________________________________________________________________ Course #3: ____________________________________________________________ _____________________________________________________________________
INSTRUCTIONS: This form should be typewritten and submitted to Family Court, Custody Investigation Unit, P. O. Box 3498, Honolulu, HI, 96811-3498.
Reprographics (07/07) 1FC Appendix 7 Effective 07/07 1F-P-727

The above courses were relevant to the following topics in the area of child custody and access (check all that apply): Courses #1 #2 #3 Child and family development Child and family mental health or psychopathology Family systems/family dynamics Parenting (including assessment of parenting ability, constructing appropriate and successful parenting plans) Effects of divorce, separation (or parents who never married/never lived together), and/or remarriage/blended families on children Family law Family/domestic violence dynamics, including: impact on children, impact of witnessing such violence, safety planning Child abuse and neglect, child sex abuse Substance abuse Safety issues that arise during the legal and evaluation processes Legal, psychosocial, mental health research regarding "high conflict" couples or "toxic litigants" (with and without domestic violence dynamics) Cultural and religious diversity Formal and informal community resources Information/data collection, assessment, and evaluation Interview techniques Evaluator bias, observer effects, and maintaining neutrality and objectivity Ethical considerations in the CE's respective profession, particularly in the context of custody evaluations Other topics relevant to the area of child custody and access (please list the topics):

DATED: Honolulu, Hawai'i, _________________________________________.

_____________________________________ Signature 2