Family Court Services Tier 2 Intake Form {PFC-24}

P lease read this ENTIRE packet very carefully. This document will provide you with important information about what to expect from your Tier 2 appointment. You MUST complete this Tier 2 Intake Form PRIOR to your Tier 2 appointment . For any information that has not changed since your last appointment with FCS please write in each section. The FCS Tier 2 Intake Form will NOT be shared with the Judicial Officer or the other parties on the case. Purpose of Tier 2 Session : The purpose of a Tier 2 session is to provide the parties with additional mediation services. During the mediation portion of the Tier 2 session, the counselor can help parties formulate a parenting plan regarding the following issues: How the children will spend time with each party (regular time and holidays) How the parties will make legal decisions about the children How the children will be transported and exchanged for the visits Participation in programs or servi ces that may be beneficial for the family Safety Considerations ***Although parents are expected to actively participate in the mediation process, parents are in NO WAY obligated to agree to a parenting plan*** An other purpose of the Tier 2 session is to provide the court with additional information regarding specific areas deemed significant by the Judicial Officer. o Although you may talk about many different areas during the mediation portion of your Tier 2 sess ion, the counselor will only provide additional information regarding the specific areas identified by the Judicial Officer and/or interview the specific people identified by the Judicial Officer . The counselor will write and submit a Tier 2 report that m ay include, but not be limited to, a description of collateral conta cts with law enforcement or Child Protective Services, interviews with the child(ren), etc. o The Tier 2 report will not include any recommendations from the counselor. o The Tier 2 report will not provide a summary of the concern/requests presented by the parties during the mediation portion of the Tier 2 session. SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO FAMILY COURT SERVICES Fresno, CA 93721 (559)457 - 2100 (option #4) FresnoFCS@fresno.courts.ca.gov Family Court Services Tier 2 Intake Form Page American LegalNet, Inc. www.FormsWorkFlow.com Family Court Services Tier 2 Intake Form Interviewing Children: The Court may order for the child ren to participate in the interview, not mediation, portion of the Tier 2 session. If the Court has ordered that the child be interviewed as part of the Tier 2 session, please make sure to bring the child ( ren ) to the Tier 2 appointment at FCS . Because the couns elor will typical ly be meeting with the parents together, this means that neither parent will be available to wait with the children in the FCS lobby . You will need to bring a NEUTRAL adult to supervise the child(ren) in the FCS lobby while you are meeting with the counse lor or you will need to bring Photo ID to check the child(ren) in to the Sisk Courthouse Childcare Center (located on the 1 st floor, next door to the FCS office). If you are using the Childcare Center, please check your children into the childcare center BEFORE you r scheduled appointment time. If ordered by the Court, the counselor will conduct a private interview with the child(ren), the parties will NOT be included when the counselor interviews the child(ren). Interpreters: If you do not speak English, you must bring your own interpreter to your mediation appointment . Failure to bring your own interpreter may result in cancellation of your Mediation appointment. Si usted no habla Ingl351s, usted debe traer su propio int351rprete. La falta de traer su propio int351rprete puede resultar en la cancelaci363n de su Mediaci363n de custodia de los hijos. Confidentiality : Pursuant to Family Code 247 3188, Mediation is private and confidential. Other than the counselor will not disclose what occurred in the mediation portion of the Tier 2 session with the following exceptions: If the counselor determines there is reasonable suspicion of danger to one of the parties or others, the counselor is required to report suspected child abuse, elder abuse, and/or if someone is a danger to themselves or others to the appropriate agency. In the event of a partial agreement the counselor will report the partial agreement to the Court. In addition, a list, in neutral terms, of the unr esolved issues may be provided to the Court with consent from all parties. Documents: The counselor has access to documents filed with the Court. The counselor has discretion to discuss documents provided by the parents during the mediation session, for the sole purpose of facilitating an agreement between the parties regarding custody and visitation. The counselor will NOT retain any documents presented by the parties during the Tier 2 mediation. If you want your documents to be considered by the Judicial Officer you assistance. Page American LegalNet, Inc. www.FormsWorkFlow.com Family Court Services Tier 2 Intake Form Separate Sessions : Pursuant to Family Code 2473181 , where there has been a history of domestic violence between the parties or where a protective order as defined in 2476218 is in effect, at the request of the party alleging domestic violence in a written declaration under penalty of perjury or protected by t he order, the counselor appointed pursuant to this chapter shall meet with the parties separately and at separate times. If you feel that separate sessions are appropriate due to a history of domestic violence, please contact Family Court Services IMMEDI request should be submitted to Family Court Services at least five days prior to your Tier 2 appointment. Orientation : If you have NOT completed the Online FCS Orientation within the last 12 months, completion of the FCS Orientation is ordered by the Court and is essential to your success in the Tier 2 session . The Orientation will provide essential information about your upcoming FCS appointment. You can view the complete FCS audio and visu al slide show Orientation Online at www.fresno.courts.ca.gov/family/familycourtservices.php The same online slide show will be show n in the FCS lobby every Friday at 1:0 0pm in English and 2:30pm in Spanish For additional information: www.fresno.courts.ca.gov/family/familycourtservices.php email: FresnoFCS@fresno.courts.ca.gov Page American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO PERSONAL INFORMATION Name: Other Names Used: (First) (Middle) (Last) (Nickname, Aliases, Maiden Name) Address: City: (Number and Street Name) (Apartment No.) State: Zip: County: Email: Phone Number(s): ( ) ( ) Date of Birth: (Home) (Work / Cell) Date of Birth: (First) (Middle) (Last) EMPLOYMENT Employer Work Schedule : MON TUES WED THURS FRI SAT SUN Work Hours: ATTORNEY N ame : Phone Number : MINOR CHILDREN IN THIS CASE N ame DOB School Name DOB School OTHER ADULTS IN YOUR HOME N ame DOB Relationship Name DOB Relationship DOMESTIC VIOLENCE 1. Is there currently a Restraining Order in effect protecting you or the other YES NO Expiration date: 2. Are you, under penalty of perjury, alleging that there is a history of domestic violence between you and the other parent? YES NO 3. If you answered YES to question #2: Were the child/ren present during the violence? YES NO Was medical attention required? YES NO Were any weapons involved? YES NO Was Law Enforcement involved? YES NO 4. Are you requesting a separate mediation session due to a history of domestic violence between you and the other parent? YES NO If yes to #4, would you like for the FCS staff to provide you with information about creating a Safety Plan: YES NO by calling (559) 457-2100 and selecting option #4 to receive a packet regarding your request for separate mediation sessions. FAMILY COURT SERVICES TIER 2 INTAKE FORM Case Number: Page : American LegalNet, Inc. www.FormsWorkFlow.com QUESTIONNAIRE 1 . Do you currently have a Court order for custody and visitation: YES NO Describe how much time each parent has with the child/ren since your separation? 2 . Please provide 2 detailed visitation schedule op