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 JUVENILE COURT JURISDICTION— CHILD ATTAINING AGE OF MAJORITY Directions for the social worker or probation officer: Check the appropriate boxes in items 1 through 6, complete item 7, attach documents as required, and sign and date item 8. Directions for the child (if child is available): Review the boxes checked by the social worker or probation officer in items 1 through 6. If the box checked in item 1 is wrong, check the correct box and sign your initials next to it. Sign your initials after items 2a–h, items 3a–g, item 4, items 5a–b, and items 6a–g if you received the service or information. Then sign and date item 9. 1. a. b. c. 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. 2. An attached report verifies that the child has received written information concerning his or her juvenile court case, including (check all that apply): a. b. c. d. e. f. g. h. Information known about the child's Indian heritage or tribal connections, if applicable The child’s family history The child's placement history The child's educational and medical history Any photographs of the child or the child's family in the possession of the county welfare department or probation department, other than forensic photographs The whereabouts of any siblings under the jurisdiction of the juvenile court The child’s right to go to the clerk’s office and, after demonstrating his or her identity by showing an identification card or by other means, inspect, receive, and copy the child’s juvenile case file without an order from the juvenile court (see Welf. & Inst. Code, §§ 826.6 and 827 and rule 5.552 of the California Rules of Court) The date on which the jurisdiction of the court will be terminated Form Adopted for Mandatory Use Judicial Council of California JV-365 [Rev. July 1, 2011) TERMINATION OF JUVENILE COURT JURISDICTION— CHILD ATTAINING AGE OF MAJORITY Page 1 of 2 Welfare and Institutions Code, § 391; Cal. Rules of Court, rule 5.740 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com JV-365 CHILD'S NAME: CASE NUMBER: 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. f. Health and education summary, as described in Welf. & Inst. Code, § 16010(a) g. Letter prepared by the county welfare department or the probation department that includes the child's name and date of birth, the dates during which the child was within the jurisdiction of the juvenile court, and a statement that the child was a foster youth in compliance with state and federal financial aid documentation requirements 4. If the child 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, the child has been provided with his or her most recent service or accommodation plan. 5. 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 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, including information about the availability of a. extended Medi-Cal benefits until age 21 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 OR PROBATION OFFICER) 9. I certify that I have received the information and services that I initialed above. Date:  (TYPE OR PRINT NAME) JV-365 [Rev. July 1, 2011) (CHILD'S SIGNATURE) TERMINATION OF JUVENILE COURT JURISDICTION— CHILD ATTAINING AGE OF MAJORITY Page 2 of 2