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Request To Change Placement Revise Or Extend Dispositional Order Review Permanency Plan JD-1766 - Wisconsin
| Request To Change Placement Revise Or Extend Dispositional Order Review Permanency Plan Form. This is a Wisconsin form and can be used in Juvenile Circuit Court Statewide . |
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For Official Use STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Request to: Change Placement Revise Dispositional Order/Consent Decree Extend Dispositional Order/Consent Decree Review Permanency Plan Name Case No. Date of Birth Child/Juvenile's Street and City Address Father's Name Father's Address Mother's Name Mother's Address Guardian, Legal/Physical Custodian Address Other Address I REQUEST THE COURT: (Check all that apply in sections 1-4.) 1. Change the placement as of . Give the reason for the new placement, why it is preferable and how it satisfies treatment plan. See attached Name and address of proposed placement The child/juvenile is placed out of the home. a. Placement in the home at this time is contrary to the welfare of the child/juvenile because: b. Reasonable efforts to prevent removal were (Complete one of the following.) made by the department or agency responsible for providing services in the following manner: made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child/juvenile from the home. not required under §48.355(2d) or §938.355(2d). JD-1766, 02/10 Request to Change Placement/Reviser/Extend Dispositional Order/Consent Decree/Review Permanency Plan §§48.357, 48.363, 48.365, 48.38, 938.357, 938.363, 938.365 and 938.38 Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Request to Change Placement/Revise/Extend Dispositional Order/Consent Decree/Review Permanency Plan Page 2 of 2 Case No. 2. Revise the dispositional order/consent decree. Specify in detail the revisions requested: See attached Because of the following new information: 3. Extend the current dispositional order/consent decree. Date current dispositional order/consent decree expires Date dispositional order/consent decree should be extended to Because of the following reasons: See attached. 4. Review permanency plan. Permanency plan is attached. is on file with the court. will be provided to the parties five days prior to the hearing. Hearing must be held on or before Date of last review hearing DISTRIBUTION: 1. Original - Court 2. Child/Juvenile and Attorney 3. Parents/Guardian/Legal Custodian/Attorney (if any) 4. Social Worker 5. Physical Custodian 6. District Attorney/Corporation Counsel 7. Guardian ad Litem 8. Court Appointed Special Advocate 9. Other: Signature Name Printed or Typed Date JD-1766, 02/10 Request to Change Placement/Reviser/Extend Dispositional Order/Consent Decree/Review Permanency Plan §§48.357, 48.363, 48.365, 48.38, 938.357, 938.363, 938.365, 938.38 and Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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