FOR COURT USE ONLY Superior Court of California, County of Nevada 201 Church Street, Suite 5 Nevada City, CA 95959 Petitioner: Respondent: ORDER APPOINTING CHILD CUSTODY EVALUATOR Court Number Court Orders 1. Pursuant to Family Code §3110 and Evidence Code §730 ______________________ Petitioner Agrees is appointed to do an evaluation. Respondent Agrees 2. The full evaluation shall be a comprehensive examination of the health, safety, and Court Orders Petitioner Agrees welfare and best interest of the child. It will include recommendations regarding legal Respondent Agrees and physical custody and terms and conditions of visitations. It could involve psychological testing and interviews with collateral contacts. Court Orders 3. The focused evaluation will consist of one or more appointments with each party, Petitioner Agrees one or more sessions with the child(ren), conjoint sessions with each party and the Respondent Agrees child(ren) if the evaluator perceives these sessions to be in the child(ren)’s best interest and collateral records review and interviews as necessary in the evaluator’s judgment. The focused evaluation is an examination of the health, safety, and welfare and the best interests of the child(ren), specifically focusing on the following areas: Terms of Visitation Request to Move Away School Related Issues Special Needs of the Child (ren) Substance Abuse Domestic Violence Mental Health/Emotional Health Issues Sibling Issues Relationship Issues Other _______________________________ _______________________________ _______________________________ Court Orders 4a. The parties are to equally share the costs of the evaluation. Petitioner Agrees by the Court at a later date. Respondent Agrees Subject to reallocation Court Orders 4b. The Petitioner is to pay _________________% of the evaluator’s fees. Petitioner Agrees The Respondent is to pay _________________% of the evaluator’s fees. Respondent Agrees Court Orders Petitioner Agrees Respondent Agrees 5. The parties are ordered to make reasonable efforts to facilitate the evaluation process, including scheduling of appointment(s) and paying fees. Parties are to contact the evaluator by ___________________. The evaluator is ordered to notify the court in the event that either party delays the evaluation as a result of an unexcused failure to schedule and/or keep appointments with the evaluator, or otherwise causes unnecessary or unreasonable delays in the evaluation process. ORDER APPOINTING CHILD CUSTODY EVALUATOR LOCAL FL15 (Effective 1/1/08) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Court Orders 6. The evaluation may be received and is agreed to be competent evidence, subject to the Petitioner Agrees right of either party to call the evaluator as a witness at their own expense. Respondent Agrees Court Orders 7. The evaluator may communicate with the child (ren)’s therapist without revealing the Petitioner Agrees specifics of the communication as to protect the child (ren)’s confidential relationship Respondent Agrees with their therapist. Court Orders 8. The report shall be filed with the court no later than ____________________. Petitioner Agrees Respondent Agrees 9. Status Conference is set on _______________ at 9:30 a.m. in Dept. III. Prior to said date of the Status Conference, set below, the parties are to return to mediation after their receipt of the evaluation to attempt to resolve any remaining issues of the parenting plan. 10. Pursuant to Family Code §216(b) ex parte communication between minor’s counsel, mediator, and/or the evaluator is expressly permitted. 11. Pursuant to Family Code §3111(b) the Custody Evaluation Report is a confidential document and may not be copied or disseminated, in whole or in part, to non-parties or other individuals without prior court order pursuant to Welfare & Institutions Code §827. A violation of this provision shall subject the offender to the imposition of sanctions and/or contempt. Petitioner Respondent Name: ____________________________ Name: ______________________________ Address: ___________________________Address: ____________________________ __________________________________ ____________________________________ Phone: ____________________________ Phone: ______________________________ Represented by: _____________________Represented by: _______________________ Children, Age: ______________________ _________________________________ Represented by:_____________________ __________________________________ IT IS SO ORDERED: DATE: _______________________ ___________________________________ JUDICIAL OFFICER cc: Evaluator Revised 03/22/07 ORDER APPOINTING CHILD CUSTODY EVALUATOR LOCAL FL15 (Effective 1/1/08) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com