PJV-28 0-18 Friday Court Screening Report SUPERIOR COURT OF CALIFORNIA COUNTY OF FRESNO Friday Court Screening Report Date of Referral: Date of Intake: Demographic Information: Name: Date of Birth: Primary Language: Ethnicity: African American American Indian As ian Caucasian Hispanic Other: Gender: Male Female Pregna nt: No Yes: Estimated delivery date: Children: No Yes: Age(s) and gender(s) of children: School of Attendance: Grade Level: Contact Information Custody Status: I i Juvenile Hall Group Home: Parent/Legal Guardian Name of Legal Guardian (or Group Home Manager): Address: Social Worker Probation Officer Contact Information: Contact Information: Case Status: Trafficking Type: Sex Trafficking Labor Trafficking At-Risk (Sex Trafficking) Phone Number: Referring Party: Attorney Probation Officer / Social Worker: Attorney: Department of Origin: American LegalNet, Inc. www.FormsWorkFlow.com Friday Court Screening Report Friday Court Screening Report Runaway Information: Number of times runaway in 12 months immediately prior to FC: Number of known days on runaway: City/County/State where youth was located when found: Was the youth exposed to or engaged in risk-taking, dangerous or unlawful behavior while on runaway status? Yes Was youth with his/her trafficker while on runaway status? Yes No Did youth suffer physical injury while on runaway status? Yes No Cumulative: Number of previous court dates: Number of Failure(s) to Appear: Felony Filings: Number of Sealed Cases: Number of Successful Completions of Probation: Background Information (For Program Evaluation Purposes) Days absent in previous semester of school: In the last year: Days in Foster Care Placement: Number of completed school credits: Days in custody awaiting placement: PJV-28 0-18 American LegalNet, Inc. www.FormsWorkFlow.com