ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL Juvenile Division 324 Applestill Rd. El Centro, CA 92243 Name of Dependant Child: CASE NUMBER: CERTIFICATION OF COMPETENCY I, (firm or affiliation, address, phone number and State Bar Number) _______________________________ ______________________________________________, am an attorney at law licensed to practice in the State of California. I hereby certify that I meet the minimum standards for practice before a Juvenile Court set forth in California Rule of Court, 5.660, and Local Rule 6.1.2, and that I have completed the minimum requirements for training, education and/or experience as set forth below: Training and Education Course Title Date Completed Hours Provider a. b. Juvenile Dependency Experience Case Number (s) Contested Hearings Date of last appearance Party Represented a. b. (Attached are copies of MCLE certificates or other documentation of attendance.) DATED:________________ ___________________________________________ Signature Form Approved for Mandatory Use JV-01 (Adopted 7/1/07, Revised 01/01/12, 01/01/13) CERTIFICATION OF COMPETENCY American LegalNet, Inc. www.FormsWorkFlow.com