West Virginia > Statewide > Family Court > Miscellaneous
Parenting Plan Home Study SCA-FC-502 - West Virginia
| Parenting Plan Home Study Form. This is a West Virginia form and can be used in Miscellaneous Family Court Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
COURT-FUNDED INVOICE PARENTING PLAN HOME STUDY EVALUATOR PAYMENT INFORMATION Name of evaluator: _________________________________________________ Make check payable to:_______________________________________________ Address for remittance:_______________________________________________ ________________________________________________ FUND 1759 Return ORIGINAL to: Misty Peal-Auville WV Supreme Court 1900 Kanawha Boulevard East Building. 1, Room E-100 Charleston, WV 25305 Phone:___________________ Fax: ___________________ E-mail address:_________________________________ Payee's Social Security Number or F.E.I.N. (whichever applies):_________________________________________ Highest Education completed: " Bachelors Degree Field : " Masters Degree " Social Work " Doctoral Degree " Law " Other " Psychology " Psychiatry " Counseling HOURLY RATE IS $45.00 FOR OUT-OF COURT AND $65.00 FOR IN-COURT, NOT EXCEEDING A TOTAL OF $750.00 HOURS SPENT ON THE CASE (MUST BE ROUNDED TO TENTHS OF AN HOUR) TASK IN-COURT OUT-OF-COURT TOTALS HOURS SPENT RATE OF PAY 65.00 45.00 - TOTAL BILLING INFORMATION: Please pay the Parenting Plan Home Study Evaluator listed above $______________ for performing an evaluation on Case # _______________ from ________________________County Amount of payment may not exceed $750.00 per case Evaluators`s Signature ______________________________________________________________ Date ________ * MUST be signed by parenting plan evaluator in blue ink Please attach a copy of the Judge's Order Approving Payment and a signed Independent Contractor's Agreement Approved by Supreme Court: _________________________________________________________ SCAFC-502 (6/03) Date:_________________ Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com Evaluator's Name: ____________________________________________________________________ PARENT CONTACT INFORMATION (1) Case # __________________________ Name: __________________________________________ Address: ____________________________________ ____________________________________ Daytime Phone: ___________________________ Evening Phone: ______________________ (2) Name: __________________________________________ Address: ________________________________________ ________________________________________ Daytime Phone: ___________________________ Evening Phone: _____________________ SESSION INFORMATION: County(ies) Conducted in: ________________________________________________________________ Did either parent fail to attend the meeting? If yes which parent(s) did not attend? " Yes " No " Father " Both " Mother Had the parties reached an agreement before the scheduled evaluation? " Yes, full agreement Mother: Father: Child(ren): " Yes, partial agreement " No agreements reached Whom did you interview? (Please list the name and the number of hours spent with each person) _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Other: Other: Other: ________________________________ _________________________________ ________________________________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ Number of hours _____________ SCAFC-502 (6/03) Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com
|
|||||||
