Free Guardian Ad Litem Checklist, JC 14:5 - Nebraska

STATE OF NEBRASKA FORM NO. JC 14:5 9/97 Revised

CASE NUMBER

GUARDIAN AD LITEM CHECKLIST
COUNTY, NEBRASKA

IN THE COUNTY COURT OF IN THE INTEREST OF

GUARDIAN AD LITEM CHECKLIST
, A Juvenile , Guardian Ad Litem appointed by this Court on , submits this report concerning the minor child(ren) involved in this

, matter, namely:

Name ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ This report is for: Disposition scheduled for Review scheduled for

Date of Birth _____________________ _____________________ _____________________ _____________________ _____________________ , ,

1. The Guardian Ad Litem met with the juvenile on the following occasions:

2. The Guardian Ad Litem has consulted with the following: Caseworker Physicians Psychologists Parents Foster parents Teachers Clergy members Others Continued...

3. As Guardian Ad Litem I have had access to and have reviewed reports provided to me by the following: Predispositional report - Probation Office Case Plan - N.D.H.H.S. YRTC evaluation _____ Kearney Other _____ Geneva

4. Recommendations: a) The guardian ad litem recommends to the Court that the juvenile undergo a medical evaluation psychological evaluation other evaluation pursuant to 43-258 b) As Guardian Ad Litem I find that reasonable efforts have been made by the Department of Social Services for the child to remain in the home. Yes No c) That the child would be in danger if placed in the home at this time and recommend removal by the Court from the home. Yes No 5. As Guardian Ad Litem I approve the case plan submitted by the Department of Social Services. Yes a) I approve but further recommend the following additional measures:

No b) Instead, I recommend the child follow specific treatments different than that recommended by the Department of Social Services:

6. As Guardian Ad Litem I intend to file the following legal action on behalf of my ward. _______Motions

7. Comments:

By: ___________________________________ Attorney at Law

_____________________________________ Guardian Ad Litem