JV-321 Request for Prospective Adoptive Parent Designation Clerk stamps date here when form is filed. After filling out this form, bring it to the clerk of the court. If you want to keep an address or telephone number confidential, do not write the information on this form. Instead, fill out Form JV-322, Confidential Information--Prospective Adoptive Parent. 1 Information about the person or persons you want to be designated as prospective adoptive parents: a. Name: b. Name: c. Street address: d. City: State: Zip: ) e. Telephone number: ( If you are not a person in 1 , fill out below. a. Name: b. I am the child child's attorney (specify role): c. Street address: d. City: State: Zip: ) e. Telephone number: ( Fill in court name and street address: Superior Court of California, County of 2 Fill in child's name and date of birth: other Child's Name: Date of Birth: Fill in case number: Case Number: 3 If you are not the child's attorney and you know who the child's attorney is, fill out below. a. Name of child's attorney: b. Street address of child's attorney: c. City: State: ) Zip: d. Telephone number of child's attorney: ( 4 The child is 10 years of age or older. Child's telephone number: or Telephone number is confidential. 5 The child has lived with the person from (date): to the present. In order for the person in 1 to become a prospective adoptive parent, the child must be living with that person now. 6 Date of Welfare and Institutions Code section 366.26 hearing: The person in 1 should not file this form with the court until a Welfare and Institutions Code section 366.26 hearing has been scheduled. 7 The person in 1 is committed to adopting the child. Judicial Council of California, www.courts.ca.gov Revised July 1, 2010, Mandatory Form Welfare and Institutions Code, �� 366.24, 366.26(n) Cal. Rules of Court, rule 5.726 Request for Prospective Adoptive Parent Designation JV-321, Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Child's name: 8 The person in 1 has (check all that apply): a. Applied for an adoptive home study b. In a case in which tribal customary adoption is the permanent plan, been identified by the Indian child's tribe as the prospective adoptive parent. c. d. e. f. g. h. i. j. Cooperated with an adoptive home study Signed an adoptive placement agreement Requested de facto parent status Been designated by the juvenile court or the licensed adoption agency as the adoptive parent Discussed a postadoption contact agreement with the social worker, child's attorney, child's Court Appointed Special Advocate (CASA) volunteer, adoption agency, or court Worked to overcome any impediments that have been identified by the California Department of Social Services or the licensed adoption agency Attended any of the classes required of prospective adoptive parent Taken other steps toward adopting the child (explain): If you need more space, attach a sheet of paper and write "JV-321, Item 8--Steps Toward Adoption" at the top. Number of pages attached: I declare under penalty of perjury under the laws of the State of California that the information in items 1 through 8 is true and correct, which means if I lie on this form, I am committing a crime. Date: Type or print your name Sign your name Type or print your name Sign your name Revised July 1, 2010 Request for Prospective Adoptive Parent Designation JV-321, Page 2 of 2