Attachment 1 Abbreviated Case Name: ________________________________________ Case No: _______________ Dept. No: ________________ Date: _________________ Next Hearing Date: ________________ Specific areas of focus: Child abuse/neglect School related issues Domestic violence Special needs of the child Substance abuse Supervised visitation Psychiatric illness Extended visitation Move away Timeshare Other: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Payment of fees for evaluation services, including preparation of report, shall be as follows: (check one) a. ___________________________________________ to pay all fees subject to the Court reserving the right to order reimbursement from the other party. b. Parties to share all fees, ________% payable by Petitioner and ________% payable by Respondent. ISSUES: (Description of issues, scope and purpose of evaluation): _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ FL/E-CT-019 Adopted for Mandatory Use April 28, 2008 Attachment to Order Appointing Child Custody Evaluator American LegalNet, Inc. www.FormsWorkflow.com