IW-1609, 09/13 Statement of Active Efforts Indian Child Welfare Act 24724748.028(4)(g) and 938.028(4)(f), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 1 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY I N THE INTEREST OF Name Statement of Active Efforts Indian Child Welfare Act Case No. Active efforts to provide remedial services and rehabilitation programs designed to prevent the breakup of the Indian family were made as follows: 1. Representatives designated by the Indian child's tribe with substantial knowledge of prevailing social and cultural standards and child - rearing practice within the tribal community were requested to evaluate the circumstances of the Indian child's family and to assist in developing a case plan that uses resources of the tribe and Indian community, including traditional and customary support, actions, and services. Yes No Describe activities or explain why not conducted: 2. A comprehensive assessment of the situation of the Indian child's family was completed, including a determination of the likelihood of protecting the child's health, safety, and welfare effecti vely in the child's home. Yes No Describe activities or explain why not conducted: 3. Representatives of the Indian child's tribe were identified, notified, and invited to participate in all aspects of the proceeding s at the earliest possible point and their advice was actively soli cited throughout the proceedings. Yes No Describe activities or explain why not conducted: 4. Extended family members of the Indian child, including extended family members who were identified by the Indian child's tribe or parents, were notified and consulted with to identify and provide family structure and support for the Indian child, to assure cultural connections, and to serve as placement resources. Yes No Describe activities or explain why not conducted: 5. Arrangements were made to provide natural and unsupervised family interaction in the most natural setting that can ensure the Indian child's safety, as appropriate to the goals of the permanency plan, including arrangements for transportation and other assistance to enable family members to p articipate in that interaction. Yes No Describe activities or explain why not conducted: 6. All available family preservation strategies were offered or employed and the involvement of the Indian child's tribe was requested to identify those strategies and to ensure they are culturally ap propriate to the tribe. Yes No Describe activities or explain why not conducted: 7. Community resources offering housing, financial, and transportation assistance and in - home support services, in - home intensive treatment services, community support services, and specialized services for members of the Indian child's family with special needs were identified, information about those resources was provided to the family, and the family was actively assisted or offered active assistan ce in accessing those resources. Yes No Describe activities or explain why not conducted: 8. Monitoring of client progress and client partici pation in services was provided. Yes No Describe activities or explain why not conducted: 9. A consideration of alternative ways of addressing the needs of the Indian child's family was provided, if services did not exist or if existing services w ere not available to the family. Yes No Describe activities or explain why not conducted: Signature Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com