Connecticut > Statewide > Juvenile
Order To Provide Educational Records And Receipt JD-JM-178 - Connecticut
| Order To Provide Educational Records And Receipt Form. This is a Connecticut form and can be used in Juvenile Statewide . |
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ORDER TO PROVIDE EDUCATIONAL RECORDS AND RECEIPT JD-JM-178 New 12/09 C.G.S. ยง 46b-121; Spec. Sess. P.A. 09-7, Sec. 70 STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Telephone number Grade Indian tribe/reservation if any Address of mother Address of father Address of guardian Address of school Telephone number Fax number Address of Court Name of child Address of child Name of mother Name of father Name of guardian, if any Name of school Name and title of contact person at school Case type Docket number Sex Date of birth Child Protection Delinquency Family With Service Needs Youth in Crisis Emancipation Other The above referenced child currently has a case pending before the Superior Court for Juvenile Matters. For purposes of determining (check all that apply): the need for services placement of the child final disposition of the case Order It is hereby ordered that the following records be provided to the Court location listed above by school transcript types of school programs enrollment status attendance reports special education academic performance school behavior expulsion and suspension meetings with parents other (date) : If records are incomplete or do not exist, please attach an explanation for the Court. Name of Judge Judge's signature Date Records produced in response to the above order shall be: -- used only for dispositional purposes and -- maintained under seal by the Court and -- released only after a hearing or with the consent of the child Receipt/Response To Order Please acknowledge receipt of the court order for educational records by signing below and returning the records to the requesting Superior Court for Juvenile Matters. (Check all that apply:) academic performance school transcript school behavior types of school programs currently expelled enrollment status meetings with parents attendance reports other special education explanation for any incomplete or non-existent records requested I certify that the items checked above are complete and accurate copies. Signed Name of person signing at left Title Date American LegalNet, Inc. www.FormsWorkFlow.com
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