California > Local County > Santa Cruz > Dependency
Dependency Mediation Referral Form SUPCV-1086 - California
| Dependency Mediation Referral Form Form. This is a California form and can be used in Dependency Santa Cruz Local County . |
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Santa Cruz Superior Court Dependency Mediation MEDIATION REFERRAL FORM Child/ren's Name(s) Case No(s) Hearing type: ___Detention ___Jurisdiction/Disposition ___6 / 12 / 18 Month Review ___366.26 Hearing ___Review After Perm Plan ___Change of Placement ___Other MEDIATION PARTICIPANTS & COUNSEL Mother: Father: Minor: Minor: CWS: DV Advocate: Relatives (specify) Interpreter ISSUES TO BE MEDIATIED ___Petition Language/Jurisdiction ___Dispositional Arrangements/Placement ___Terms of Family Maintenance/Reunification ___Custody/Visitation ___6 or 12 Month Review Recommendations ___Kinship Adoption Agreement/Discussion ___Communication/Relational Issues DOMESTIC VIOLENCE Are there domestic violence issues present? ___Yes ___No ___Termination of Services ___Counseling ___Drug Testing ___Availability of Services ___Other Issues/Limitations Represented by Represented by Represented by Represented by Represented by CASA Mediation Requested By: ___Court ___Mother ___Father ___CWS ___Minor ___Other Case Type: ___300(a) ___300(f) ___300(g) Age(s) ___342 (Subsequent) ___300(b) ___387(Supplemental) ___388 (Modified) ___300(c) ___300(d) ___300(e) ___Other ___300(h) ___300(i) ___300(j) (If so, hand out Dependency Mediation Procedural Rights in domestic violence cases to victim party) Is there a Domestic Violence Protective Order in effect? ___Yes ___No Please forward a copy with the referral. Date of Mediation__________________________ Time_________________ Location: Superior Court, Family Court Services, 1 Second Street, Room 303, Watsonville, CA Next Court Date_________________________ Time________________ Department A The parties and their attorneys are ordered to mediate the resolution of this case in the Dependency Mediation Program. Date Judge of the Dependency Court CLERK: Please attach copy of: ___Minute Order ___Responses to Latest CWS Report ___Latest CWC Report SUPCV1086 (Rev. 11/1/10) American LegalNet, Inc. www.FormsWorkFlow.com
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