In order for a CASA volunteer to be appointed as the educational representative, a Judicial Council of California Form JV-535 limiting the educational rights of the parent(s) must be signed by the judicial officer and filed with the Court. Rev. 12/2017 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Sate Bar Number, and Address) TELEPHONE NO: EMAIL ADDRESS (Optional) : FOR COURT USE ONLY Superior Court of California , County of San Francisco Juvenile Justice Center 375 Woodside Avenue, Room 101, San Francisco, CA 94127 Civic Center Courthouse 400 McAllister Street, Room 402, San Francisco, CA 94102 CASE NAME: PIN (if applicable): REQUEST FOR COURT APPOINTED SPECIAL ADVOCATE (CASA) AND/OR EDUCATIONAL RIGHTS HOLDER REFERRAL PETITION NUMBER: 1. Name of Youth: Date of Birth: 2. Gender Identity: Race: Ethnicity: 3. Current Placement City: I am requesting a: CASA Educational Rights Holder Date: Applicable parties noticed: Attorney for Dependent/Ward HSA-FCS JPD City and/or District Attorney Name of Referent and Relationship to Youth (Print) Signature of Referent American LegalNet, Inc. www.FormsWorkFlow.com