JV-365 ATTORNEY OR PARTY WITHOUT ATTORNEY NAME: FIRM NAME: STREET ADDRESS: CITY: TELEPHONE NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): STATE: FAX NO.: ZIP CODE: STATE BAR NO: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: NONMINOR'S NAME: NONMINOR'S DATE OF BIRTH: HEARING DATE AND TIME: CASE NUMBER: TERMINATION OF JUVENILE COURT JURISDICTION--NONMINOR Directions for the social worker or probation officer: Check the appropriate boxes in items 1 through 7, complete item 8, attach documents as required, and sign and date item 9. Directions for the nonminor (if nonminor is available): Review the boxes checked by the social worker or probation officer in items 1 through 7. If the box checked in item 1 is wrong, check the correct box and sign your initials next to the box. Sign your initials on the lines after items 2a­h, 3a­j, 4, 5a­b, 6, and 7a­h only if you received the information, document, or service described in that item. Then sign and date item 10. You may give the form to the judge on the day of the hearing if you didn't give it to your social worker, probation officer, or attorney before the hearing. 1. a. b. c. The nonminor wants to attend the termination hearing in person by telephone. The nonminor does not want to attend the termination hearing. The petitioner has attached verification that the nonminor has been informed of the potential consequences of failure to attend the termination hearing. The nonminor is unavailable or has refused to sign this form. Documentation of reasonable efforts to locate the nonminor and to obtain his or her signature is attached. 2. An attached report verifies that the nonminor has received written information about his or her juvenile court case, including (check all that apply): a. b. c. d. e. f. g. The nonminor's Indian heritage or tribal connections ________ The nonminor's family history ________ The nonminor's placement history ________ The nonminor's educational history and medical history ________ Any photographs of the nonminor or his or her family in the possession of the county welfare department or probation department, other than forensic photographs ________ Contact information for all siblings under juvenile court jurisdiction, except for any siblings whose safety or welfare would be jeopardized by contact with the nonminor, as determined by the court ________ Instructions on how the nonminor may exercise his or her right to inspect, receive, and copy his or her juvenile case file, including how to access sealed records (see Welf. & Inst. Code, §§ 389(a), 781(a)(4), 786(f)(1)(F), 826.6 & 827; Cal. Rules of Court, rule 5.552) ________ The date on which the jurisdiction of the court would be terminated ________ h. 3. The nonminor has been provided with the following documents (check all that apply): a. b. c. d. e. f. A certified copy of his or her birth certificate ________ His or her social security card ________ His or her California identification card or driver's license ________ Proof of his or her citizenship or lawful permanent resident status ________ A copy of the death certificate of his or her parent or parents ________ His or her Health and Education Passport ________ Page 1 of 2 Form Adopted for Mandatory Use Judicial Council of California JV-365 [Rev. January 1, 2017] TERMINATION OF JUVENILE COURT JURISDICTION--NONMINOR Welfare & Institutions Code, §§ 391, 607.2, 607.3; Cal. Rules of Court, rule 5.555 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-365 NONMINOR'S NAME: CASE NUMBER: 3. g. h. A blank advance health care directive form ________ A letter prepared by the county welfare department that includes the nonminor's name and date of birth, the dates during which he or she was within the jurisdiction of the juvenile court, and a statement that the nonminor was a foster child in compliance with state and federal financial aid documentation requirements ________ The nonminor's 90-day Transition Plan _______ A copy of each of the following: How to Ask to Return to Juvenile Court Jurisdiction and Foster Care (form JV-464-INFO), a blank Request to Return to Juvenile Court Jurisdiction and Foster Care (form JV-466), and a blank Confidential Information--Request to Return to Juvenile Court Jurisdiction and Foster Care (form JV-468) ________ The nonminor continues to be eligible for services or accommodations under the Individuals with Disabilities Education Act, the Americans with Disabilities Act, or section 504 of the Rehabilitation Act of 1973, and he or she has been provided with his or her most recent service or accommodation plan. ________ The nonminor has been receiving services as provided in the Individuals with Disabilities Education Act (see 34 C.F.R. §§ 300.320(b)­(c) & 300.321(b)) and i. j. 4. 5. a. b. 6. has received a copy of his or her transition service plan. ________ has been informed of the rights that will transfer to him or her under this Act. ________ The nonminor was informed that state agencies, when hiring for internships and student assistant positions, must give preference to qualified applicants up to 26 years of age who are or have been dependent children in foster care. ________ 7. The nonminor received the following assistance or services (check all that apply): a. Written verification of continued enrollment in Medi-Cal with no interruption in coverage, and provision of ________ i. ii. b. c. d. e. f. g. h. His or her Medi-Cal Benefits Identification Card (BIC) ________ Information about eligibility for extended Medi-Cal benefits until age 26 ________ Help applying to college, a vocational training program, or another educational or employment program ________ Help obtaining financial aid for college, a vocational training program, or another educational or employment program ________ A referral to transitional housing, if available, or assistance in securing other housing ________ Help obtaining employment or other financial support ________ including completing enrollment in CalFresh ________ Help maintaining relationships with individuals important to him or her, consistent with his or her best interests (required only if the nonminor has been in an out-of-home placement for six months or longer) ________ Help accessing the Independent Living Aftercare Program in the nonminor's county of residence ________ Other services ordered by the court (specify): 8. Number of pages attached: I declare