Guardian Ad Litem Information Form

CASE INFORMATION

Case Number:

Court Date (if any):

PERSONAL INFORMATION

Your Name:

Home Address:

Email Address:

Home Phone: Cell Phone:

Employer Name/Address:

Employer Phone:

Hours Worked Per Week:

Which phone number is best during daytime? (Circle One)

Home Work Cell

Your Date of Birth:

Your Social Security #:

Your Driver’s License #: State of Issue:

PHOTO COPY OF YOUR DRIVER'S LICENSE REQUIRED

Upload Driver's License Copy:

School District In Which You Reside:

INFORMATION REGARDING CHILD(REN)

Child 1

Child’s Name:

Address:

Age: Date of Birth: SSN:

Present School:

Address:

School Phone No.: Grade:

Teacher Name:

School Counselor:

Prior School(s) Attended:

Child’s Doctor:

Doctor Address:

Private Counselor (if any):

Address:

Phone:

Child 2

Child’s Name:

Child 3

Child’s Name:

Child 4

Child’s Name:

OTHER ADULT MEMBERS OF HOUSEHOLD

List names of all other adults residing in your residence:

Adult 1

Name:

Relationship to you:

Age: Phone:

Employer:

How long has person resided with you?

Adult 2

Name:

Adult 3

Name:

Adult 4

Name:

ISSUES INVOLVING CHILDREN

State what issues (if any) you are currently experiencing regarding your child(ren):

EXPECTATIONS FROM COURT PROCEEDINGS

State what you prefer the outcome of your court proceedings to be regarding your minor children and state all information or occurrences you would like to be considered in support of your preferred outcome:

GUARDIAN AD LITEM INFORMATION FORM

CASE INFORMATION

PERSONAL INFORMATION

INFORMATION REGARDING CHILD(REN)

Child 1

Child 2

Child 3

Child 4

OTHER ADULT MEMBERS OF HOUSEHOLD

Adult 1

Adult 2

Adult 3

Adult 4

ISSUES INVOLVING CHILDREN

EXPECTATIONS FROM COURT PROCEEDINGS