SV-100 Petition for Orders to Stop Private Postsecondary School Violence Clerk stamps date here when form is filed. Read How Do I Get an Order to Prohibit Private Postsecondary School Violence? (Form SV-100-INFO) before completing this form. Also fill out Form SV-102, CLETS Information, with as much information as you know. 1 Petitioner (Educational Institution Officer or Employee) Name: is the chief administrative officer Fill in court name and street address: an officer or employee designated by the chief administrative officer to maintain order on the campus or facility of (name of private postsecondary educational institution): Superior Court of California, County of and is filing this petition on behalf of the student in 2 . Address (skip this if you have a lawyer): Court fills in case number when form is filed. Case Number: City: State: Telephone: Zip: Fax: E-mail Address (optional): Lawyer for Petitioner (if any): Name: State Bar No.: Firm Name: Street Address: City: State: Telephone: Zip: Fax: E-mail Address: 2 Student in Need of Protection (Protected Person) Full Name: Sex: M F Age: 3 Respondent (Person From Whom Protection Is Sought) Age: Full Name: Home Address (if known): City Work Address (if known): State: Zip: City State: Zip: Judicial Council of California, www.courts.ca.gov New January 1, 2011, Mandatory Form Code of Civil Procedure, §§ 527.85 and 527.9 This is not a Court Order. Petition for Orders to Stop Private Postsecondary School Violence SV-100, Page 1 of 6 (Private Postsecondary School Violence Prevention) American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 4 Additional Protected Persons a. Are you asking for protection for any family or household members or any other students at the campus or facility who are similarly in need of protection? Yes No If yes, list those persons below: Sex Full Name Age Household Member? Relationship to Student Yes Yes Yes No No No Additional protected persons are listed in Attachment 4a. Response is stated in Attachment 4b. b. Why do these people need protection? (Explain): 5 Relationship of Student and Respondent a. How does the student know the respondent? (Describe): Response is stated in Attachment 5a. b. Respondent is is not a current student of petitioner (explain any decision to retain, expel, or otherwise discipline the respondent): Response is stated in Attachment 5b. 6 Venue Why are you filing in this county? (Check all that apply): a. The respondent lives in this county. b. c. 7 The respondent has caused physical or emotional injury to the student in this county. Other (specify): Other Court Cases a. Has the student or any of the persons named in 4 been involved in another court case with the respondent? No If yes, check each kind of case and indicate where and when each was filed: Yes County Where Filed (1) Kind of Case Civil Harassment (2) Domestic Violence (3) Divorce, Nullity, Legal Separation (4) Paternity, Parentage, Child Support (5) Elder or Dependent Adult Abuse (6) Year Filed Case Number (if known) Eviction New January 1, 2011 This is not a Court Order. Petition for Orders to Stop Private Postsecondary School Violence (Private Postsecondary School Violence Prevention) SV-100, Page 2 of 6 Case Number: County Where Filed (7) (8) Guardianship Workplace Violence (9) Year Filed Case Number (if known) Criminal Other (specify): (10) b. Are there now any restraining orders or criminal protective orders in effect relating to the student or any of the persons in 4 and the respondent? Yes No If yes, attach a copy if you have one. 8 Description of Respondent’s Conduct a. Respondent has (check one or more): (1) assaulted, battered, or stalked the student. (2) made a credible threat of violence against the student by making knowing or willful statements, or engaging in a course of conduct, that served no legitimate purpose and that would place a reasonable person in fear for his or her safety or the safety of his or her immediate family. b. One or more of these acts were made off the school campus or facility and can reasonably be understood (check either or both): (1) to have been carried out at the school campus or facility. (2) to be carried out in the future at the school campus or facility. Address of campus or facility: c. Describe what happened. (Provide details. Include the dates of all incidents beginning with the most recent; tell who did what to whom; identify any witnesses.): Response is stated in Attachment 8c. d. Was the student harmed or injured? Yes No If yes, describe harm or injuries: Response is stated in Attachment 8d. e. Did the respondent use or threaten to use a gun or any other weapon? Yes No If yes, describe: Response is stated in Attachment 8e. New January 1, 2011 This is not a Court Order. Petition for Orders to Stop Private Postsecondary School Violence (Private Postsecondary School Violence Prevention) SV-100, Page 3 of 6 Case Number: f. For any of the incidents described above, did the police come? Yes No I don’t know If yes, did the student or the respondent receive an Emergency Protective Order? Yes No I don’t know If yes: The order protects (check all that apply): (3) (1) The respondent One or more of the persons in 4 The student (2) Attach a copy of the order if you have one. 9 Check the orders you want.  Personal Conduct Orders I ask the court to order the respondent not to: a. assault, batter, or stalk the student and other protected persons. b. c. make threats of violence to the student and other protected persons. follow or stalk the student and other protected persons during school hours or to or from the school campus or facility. contact the student and other protected persons, directly or indirectly, by any means, including but not limited to, in person, by telephone, in writing, by public or private mail, by interoffice mail, by e-mail, by text messaging, by fax, or by other electronic means. enter the school campus or facility of the student and other protected persons. take any action to obtain the address or location of the student and other protected persons. other specify): d. e. f. g. 10 Stay-Away Orders a. I ask the court to order the respondent to stay at least yards away from the student and each other protected person listed in 4 and (check all that apply): (1) (2) (3) (4) (5) the student’s and other protected persons’ homes the student’s and other protected persons’ jobs or workplaces the student’s and other protected persons’ vehicles the student’s and other protected persons’ schools other (specify): b. If the court orders the respondent to stay away from all the places listed above, will he or she still be able to get to his or her home, school, or job? Yes No If no, explain: Response is stated in Attachment 10b. New January 1, 2011 This is not a Court Order. Petition for Orders to Stop Private Postsecondary School Violence (Private Postsecondary School Violence Prevention) SV-100, Page 4 of 6 Case Number: 11 Firearms Prohibition and Relinquishment If the judge grants a protective order, the respondent will be prohibited from owning, possessing, purchasing, receiving, or attempting to purchase or receive a gun or other firearm while the protective order is in effect. The respondent will also be ordered to turn in to law enforcement or sell to a gun dealer any guns or firearms within his or her immediate possession or control. Does the respondent own or possess any guns or other firearms? Yes No I don’t know 12 Request for Immediate Orders Without Notice Do you want the court to make any of these orders now that will last until the hearing without notice to the respondent? Yes No If you answered yes, explain why: Response is stated in Attachment 12. 13 Request for Less Than Five-Days' Notice You must have your papers personally served on the respondent at least five days before the hearing, unless the court orders a shorter time for service. (Form SV-200-INFO explains what is proof of personal service. Form SV-200, Proof of Personal Service, may be used to show the court that the papers have been served.) If you want there to be fewer than five days between service and the hearing, explain why: Response is stated in Attachment 13. 14 No Fee for Filing I ask the court to waive the filing fee because the respondent has threatened violence against the student, or stalked the student, or acted or spoken in a manner that has placed the student in reasonable fear of violence. 15 No Fee to Serve Orders I ask the court to order the sheriff or marshal to serve the respondent with the orders for free because this request for orders is based on a credible threat of violence or stalking. New January 1, 2011 This is not a Court Order. Petition for Orders to Stop Postsecondary School Violence (Private Postsecondary School Violence Prevention) SV-100, Page 5 of 6 Case Number: 16 Court Costs I ask the court to order the respondent to pay my court costs. 17 Additional Orders Requested I ask the court to make the following additional orders (specify): Additional orders requested are stated in Attachment 17. 18 Number of pages attached to this form, if any: Date: Lawyer’s name (if any) Lawyer’s signature I declare under penalty of perjury under the laws of the State of California that the information above and on all attachments is true and correct. Date: Name and title of person signing for petitioner Signature I consent to the filing of this petition. Date: Name of student New January 1, 2011 Signature This is not a Court Order. Petition for Orders to Stop Private Postsecondary School Violence (Private Postsecondary School Violence Prevention) SV-100, Page 6 of 6