ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CRUZ ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CRUZ  Santa Cruz 701 Ocean Street, Room 110 Santa Cruz, CA 95060  Watsonville Branch 1 Second Street, Room 300 Watsonville, CA 95076 Petitioner: Respondent: ORDER APPOINTING CHILD CUSTODY ASSESSOR/EVALUATOR (FCS) CASE NO. FOR COURT USE ONLY Date of First Appointment: _______________ THIS IS A TWO-PAGE COURT ORDER FOR A CHILD CUSTODY/VISITATION ASSESSMENT OR EVALUTION 1. APPOINTMENT AND AUTHORITY/PURPOSE AND SCOPE Pursuant to Evidence Code § 730, Family Code §§ 3110-3112 and rule 5.220 - 5.225 of the California Rules of Court, the Court appoints: [ ] Family Court Services [ ] to conduct: [ ] a partial custody or visitation evaluation (assessment). [ ] a full custody or visitation evaluation. [ ] a psychological evaluation. [ ] an evaluation pursuant to Family Code § 3118. A. ASSESSMENT/EVALUATION RECOMMENDATIONS: The recommendations resulting from the assessment/evaluation shall address the issues checked below: [ ] Legal Custody, may include division of authority for decision making [ ] Physical Custody [ ] Visitation [ ] Whether visitation shall be supervised, and if so, by what type of program and for how long [ ] Exchange provisions designed to protect the child from exposure to extreme conflict or domestic violence, and to protect the safety of all the parties [ ] Move-away issues [ ] Whether either party shall be required to attend counseling, rehabilitation, parenting, or co-parenting programs, substance abuse counseling domestic violence programs, and, if so, which programs and for how long. [ ] Whether the child shall participate in counseling programs and, If so, the method for selecting the counselor [ ] Other: [ ] Other recommendations related to any of the above issues necessary for clarification or implementation of the recommended order, or otherwise required to address the health, safety, welfare, and best interests of the child. 2. EVALUATION/ASSESSMENT FEES AND COSTS [ ] Each party shall be responsible for 50% of the cost of the evaluation/assessment. [ ] Payment as follows: ORDER APPOINTING CHILD CUSTODY ASSESSOR/EVALUATOR (FCS) SUP CV 1054 (Rev. 11/20/07) Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com 3. ASSESSOR/EVALUATOR DUTIES, AUTHORITY, AND ACCESS TO INFORMATION A. The assessor/evaluator shall adhere to the requirements of California Rules of Court, Rule 5.220 – 5.225 and Rule 5230, Domestic Violence Training for Court Appointed Evaluators. B. The assessor/evaluator shall have the authority to conduct home visits at his/her discretion. C. The assessor/evaluator shall, at her/his discretion, have access to the child(ren)’s medical, dental, mental health, and other health care records, school and educational records, and the right to interview school personnel, caretakers, health care providers, mental health professionals, and others who have assessed the child(ren) or provided care to the child(ren). Each party shall sign releases for such information as requested by the evaluator/assessor. D. The assessor/evaluator shall have access to any and all reports, test results, and other documents relating to the children from third parties, for example, but not limited to: mental health professionals, school personnel, Child Protective Services workers, medical and dental care providers, and day care providers. Each party shall sign releases for such information as requested by the evaluator/assessor. E. The assessor/evaluator shall have the authority to contact any previously court appointed custody/visitation assessor/evaluator who shall have the authority to release case-related information to the evaluator/assessor appointed by this order. Contact with any previously appointed Special Master shall be as specified by court order only. F. All information obtained as described above shall be used solely for the purpose of conducting the assessment/evaluation. G. In the event that the Court has checked the box above ordering an evaluation pursuant to Family Code § 3118, the Court has determined that there is a serious allegation of child sexual abuse as defined in section 3118. The evaluator appointed herein shall fully comply with all applicable requirements of Family Code § 3118. Any evaluator appointed under Section 3118 shall have access to all Juvenile Court records pertaining to the child who is the subject of the evaluation. Any Juvenile Court records or information gained from those records shall remain confidential and shall only be released as specified in Family Code § 3111. The evaluation shall be suspended if a petition is filed to declare the child a dependent child of the Juvenile Court pursuant to section 300 of the Welfare & Institution Code, and all information gathered by the evaluator shall be made available to the Juvenile Court. H. Assessments/evaluations may be placed in a confidential envelope at the discretion of the court. 4. Other Orders: IT IS SO ORDERED: DATED: _____________________________________________________ JUDICIAL OFFICER ORDER APPOINTING CHILD CUSTODY ASSESSOR/EVALUATOR (FCS) SUP CV 1054 (Rev. 11/20/07) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com