FL-325 EVALUATOR (Name and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: DECLARATION OF COURT-CONNECTED CHILD CUSTODY EVALUATOR REGARDING QUALIFICATIONS 1. I, (name): to the truth of the facts in this declaration. , declare that if I appeared in court and were sworn, I would testify , I am a court-connected child custody evaluator or a person who supervises 2. As of (date): court-connected child custody evaluators for the above court. 3. I submit this form to indicate compliance with all applicable requirements for a court-connected child custody evaluator under rule 5.225 of the California Rules of Court for (specify year): . LICENSING REQUIREMENTS 4 a. b. 5. a. I am licensed as a psychologist, marriage and family therapist, or clinical social worker; I am licensed as a physician and I am a board-certified psychiatrist, or I have completed a residency in psychiatry; or I am not licensed, but I am eligible to be certified by the court to perform court-connected child custody evaluations under Family Code section 3110.5(c)(5) and rule 5.225(c)(2)(A) because: (1) I meet the requirements for a court-connected child custody evaluator under rule 5.225(j); and (2) I am being supervised by a court-connected child custody evaluator who has complied with all the requirements for court-connected child custody evaluators under rule 5.225; and I request that the court certify that I meet all the requirements for a court-connected evaluator under rule 5.225. I am not licensed or eligible for certification as indicated in item 4 or 5. NOTICE: If item 6 is checked, the court may not appoint the person to perform a child custody evaluation in this case unless, under Family Code section 3110.5(d) and rule 5.225(c)(2)(B), all the following criteria have been met: (1) The court determined that there are no licensed or certified evaluators who are willing and available, within a reasonable period of time, to perform child custody evaluations; (2) The parties have stipulated that the person may conduct the child custody evaluation; and (3) The court approves the person's appointment. b. 6. EDUCATION AND TRAINING REQUIREMENTS 7. I have completed: a. b. c. The basic and advanced domestic violence training requirements for a court-connected child custody evaluator under rule 5.225(e); and The 40 hours of education and training requirements for a court-connected evaluator under rule 5.225(d); or At least 20 of the 40 hours of the education and training requirements for a court-connected evaluator. I will complete the remaining hours of education and training required by rule 5.225(d) within 12 months of conducting my first evaluation as a court-connected child custody evaluator. CONTINUING EDUCATION AND TRAINING REQUIREMENTS 8. a. I have recently completed the initial education and training in item 7. I must complete the continuing education and training requirements of rule 5.225(i) by (specify date): (within 18 months after completing the initial education and training described in items 7a and 7b). Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California FL-325 [Rev. January 1, 2011] DECLARATION OF COURT-CONNECTED CHILD CUSTODY EVALUATOR REGARDING QUALIFICATIONS Family Code, §§ 1816, 3110.5; Cal. Rules of Court, rules 5.225, 5.230 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com FL-325 EVALUATOR'S NAME: 8. b. I have completed the continuing education and training requirements within the 12-month period immediately preceding the date I signed this declaration: (1) (2) 8 hours of update training requirements covering the subjects described in rule 5.225(d) 4 hours of domestic violence update training under rule 5.230 9. I have complied with the experience requirements for a court-connected child custody evaluator specified in rule 5.225(g) because I participated in the completion of four court-appointed child custody evaluations in the preceding three years. a. b. I independently conducted and completed the child custody evaluations as stated in rule 5.225(g)(1)(A); or I materially assisted another evaluator as stated in rule 5.225(g)(1)(B). 10. I have complied with the experience requirements for those who supervise court-connected child custody evaluators because I conducted or materially assisted in the completion of four court-connected child custody evaluations in the preceding three years as stated in rule 5.225(g)(3). I have not complied with the experience requirements for child custody evaluators stated in rule 5.225(g)(1). NOTICE: If item 11 is checked, the court may not appoint a court-connected evaluator to perform a child custody evaluation unless, under rule 5.225(g)(2), all the following criteria have been met: 1. The court determined that there are no child custody evaluators who meet the experience requirements for child custody evaluators who are willing and available, within a reasonable period of time, to perform child custody evaluations; 2. The parties have stipulated that the person may conduct the evaluation; and 3. The court approves the person's appointment. 11. USE OF INTERNS 12. I intend to use interns to assist with the child custody evaluation in the manner disclosed and agreed to by the parties and attorneys in the case. Each intern will have complied with the criteria of rule 5.225(m) and will work under my supervision at all times. NOTICE All court-connected child custody evaluators must submit this form to the court executive officer or his or her designee. Court-connected child custody evaluators appointed as of January 1 of a given year must submit this form by January 30 of that year. Court-connected evaluators beginning practice after January 1 must submit this form before beginning any work on the first child custody evaluation and by January 30 of every year thereafter. (Cal. Rules of Court, rule 5.225(l)(1)(A).) I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) CERTIFICATION BASED ON THE FOREGOING, THE COURT CERTIFIES THAT THE ABOVE PERSON IS A COURT-CONNECTED CHILD CUSTODY EVALUATOR WHO MEETS ALL THE QUALIFICATIONS FOR COURT-CONNECTED EVALUATORS AS SPECIFIED BY THE JUDICIAL COUNCIL IN RULE 5.225 OF THE CALIFORNIA RULES OF COURT. Date: JUDGE COMMISSIONER FL-325 [Re