JV-539 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (Name): FAX NO.: SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CHILD'S NAME: REQUEST FOR HEARING REGARDING CHILD'S ACCESS TO SERVICES NOTICE OF HEARING 1. A hearing on this application will be held as follows: a. b. Date: Address of court: Time: is shown above Dept: is (specify): CASE NUMBER: Div: Room: Appointment of Educational Rights Holder 2. On (date): the educational rights holder resigned or is no longer serving in that capacity. the surrogate parent resigned or was terminated. I am requesting a hearing for appointment of an educational rights holder. Date: (TYPE OR PRINT NAME) ATTORNEY FOR CHILD OR YOUTH SOCIAL WORKER OR PROBATION OFFICER SIGNATURE Review of Proposed Removal From School of Origin 3. On (date): , the social worker or probation officer informed me that the child's or youth's placement will be changed and that this will result in the removal of the child or youth from the school of origin. Based on the information provided to me by the social worker or probation officer, I am requesting a hearing for the court to review the proposed removal of the child or youth from the school of origin. Date: (TYPE OR PRINT NAME) ATTORNEY FOR CHILD OR YOUTH EDUCATIONAL RIGHTS HOLDER SIGNATURE Page 1 of 1 Form Approved for Optional Use Judicial Council of California JV-539 [Rev. January 1, 2014] REQUEST FOR HEARING REGARDING CHILD'S ACCESS TO SERVICES Welfare and Institutions Code, §§ 362, 727; Education Code, §§ 48853.5, 49069.5; Cal. Rules of Court, rule 5.651 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com