ATTACHMENT JV-2004 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NUMBER: FOR COURT USE ONLY ATTORNEY FOR: (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH: 191 North First Street San Jose, CA 95113 In the Matter of (Name of Child), a Minor, [D.O.B. ] CASE NUMBER: APPLICATION AND ORDER RE APPOINTMENT OF COURT DESIGNATED CHILD ADVOCATE Court Designated Child Advocates applies to the Court for the appointment of as the Child Advocate in behalf of the Minor. (Check one:) This case was referred by the Court to Court Designated Child Advocates for a determination whether the Child Advocate program can undertake the case. The Child Advocate designated above is currently serving as the Court Appointed Child Advocate in behalf of the Minor in a proceeding brought pursuant to Welfare & Institutions Code section 300. Date: COURT DESIGNATED CHILD ADVOCATES By: Type / Print Name: COURT ORDER The Application is granted. The Application is set for hearing on: hearing date to: District Attorney Parent(s) or Guardian(s) Child The Application is denied. Additional Orders: Attorney for child Probation Department Other: . Applicant shall give ten days' notice of Date: Judicial Officer JV-2004 REV 7/01/08 APPLICATION AND ORDER RE APPOINTMENT OF COURT DESIGNATED CHILD ADVOCATE Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com