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Termination Of Dependency Jurisdiction-Child Attaining Age Of Majority Form. This is a California form and can be use in Juvenile Judicial Council.
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Tags: Termination Of Dependency Jurisdiction-Child Attaining Age Of Majority, JV-365, California Judicial Council, Juvenile
JV-365
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
TELEPHONE NO.:
FOR COURT USE ONLY
FAX NO. (Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
CHILD'S NAME:
CHILD'S DATE OF BIRTH:
HEARING DATE AND TIME:
DEPT.:
CASE NUMBER:
TERMINATION OF DEPENDENCY JURISDICTION—
CHILD ATTAINING AGE OF MAJORITY
Directions for the social worker: Check the appropriate boxes in items 1 through 4, complete item 5, attach documents as required,
and then sign and date item 8.
Directions for the child (if child is available): Review the boxes checked by the social worker in items 1 through 6. Sign your initials
after each item if you received the service or information. Then sign and date item 9.
1. a.
b.
c.
2.
The child wants to attend the termination hearing.
The child does not want to attend the termination hearing. The petitioner has attached verification that the child has been
informed of the potential consequences of failure to attend the termination hearing.
The child is unavailable and/or has refused to sign this form. Evidence of reasonable efforts to locate the child and to
obtain the child’s signature is attached.
An attached report verifies that the child has received written information concerning his or her dependency case, including
information about the child’s family history; the child's placement history; the child's educational and medical history; the
whereabouts of any siblings under the jurisdiction of the juvenile court; the procedures for accessing the documents that the
child is entitled to inspect under Welfare and Institutions Code section 827; and the date on which the jurisdiction of the court
will be terminated.
3. The child has been provided with the following documents (check all that apply):
Certified birth certificate
a.
Social security card
b.
Identification card and/or driver’s license
c.
Proof of citizenship or residency status
d.
Death certificate of parent or parents, if applicable
e.
Health and education summary
f.
Proof of dependency/wardship
g.
4.
If the child continues to be eligible for services or accommodations pursuant to the Individuals With Disabilities Education Act,
the Americans With Disabilities Act, or section 504 of the Rehabilitation Act of 1973, the child has been provided with his or
her most recent service or accommodation plan.
Form Adopted for Mandatory Use
Judicial Council of California
JV-365 [Rev. January 1, 2008]
TERMINATION OF DEPENDENCY JURISDICTION—
CHILD ATTAINING AGE OF MAJORITY
Page 1 of 2
Welfare and Institutions Code, § 391;
Cal. Rules of Court, rule 5.740
www.courtinfo.ca.gov
American LegalNet, Inc.
www.FormsWorkflow.com
JV-365
CHILD'S NAME:
CASE NUMBER:
The child has been receiving services as provided in the Individuals With Disabilities Education Act (34 C.F.R.
§§ 300.320(b) and (c), 300.321(b), and
5.
the child has received his or her transition service plan.
the child has been informed of the rights that will transfer to him or her under this act.
a.
b.
6. The child has received the following:
Assistance with an application for Medi-Cal or other health insurance
a.
Assistance with an application for college, a vocational training program, or another educational or employment program
b.
Information on obtaining, or an application to obtain, financial assistance for educational and employment programs
c.
A referral to transitional housing, if available, or assistance in securing other housing
d.
e.
Assistance in obtaining employment or other financial support
f.
Assistance in maintaining relationships with individuals who are important to the child, consistent with the child's best
interest (required only if the child has been in out-of-home placement for six months or longer)
Other services ordered by the court (specify):
g.
7. Number of pages attached:
8. I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct.
Date:
(TYPE OR PRINT NAME)
(SIGNATURE OF SOCIAL WORKER)
9. I certify that I have received the information and services that I initialed above.
Date:
(TYPE OR PRINT NAME)
JV-365 [Rev. January 1, 2008]
(CHILD'S SIGNATURE)
TERMINATION OF DEPENDENCY JURISDICTION—
CHILD ATTAINING AGE OF MAJORITY
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