PERMANENCY PLAN ORDER AND REVIEW STATE OF CONNECTICUT JD-JM-129 Rev. 7-15 C.G.S. §§ 46b-129(k), 17a-111b(c), 17a-112(o) P.A. 15-199 P.B. § 35a-14 Address of Court Name of Petitioner Name of Father Name of Mother Name of Guardian (If applicable) SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Docket Number Name of Child or Youth Address of Father Address of Mother Address of Guardian (If applicable) Date of Birth Upon hearing on the Petitioner's Motion for Review of Permanency Plan, and upon considering the best interests of the child or youth named above, including the child's or youth's health and safety and need for permanency, the Court makes the following findings and orders in conformity with the provisions of the Connecticut General Statutes: I. Achieve the Plan Finding Reasonable efforts to achieve the permanency plan were II. Permanency Plans 1. Permanency Plan Goals: A. Revocation of Commitment and reunification of the child or youth with the Mother B. Father Legal Guardian With protective supervision Without protective supervision made. not made. Transfer of guardianship to (Name): Or Permanent legal guardianship to (Name): C. Filing of Petition for Termination of Parental Rights (TPR) and adoption The TPR Petition shall be filed no later than 60 days after the court approves the permanency plan (date): . The Department of Children and Families (DCF) shall place the child on the photo-list within thirty days of the approval of a permanency plan. D. Another planned permanent living arrangement for a child sixteen years of age or older. DCF has documented a compelling reason why including the goals in (A) through (C) above would not be in the best interests of the child or youth. Placement of the youth in an independent living program, or Placement of the youth in long term foster care with an identified foster parent (Name) Other , or (Continued) American LegalNet, Inc. www.FormsWorkFlow.com E. The court does not approve the permanency plan and the Petitioner is ordered to submit another permanency plan no later than: (date) and a hearing on the plan will be held on: (date) . The court consolidates the permanency plan hearing with the hearing/trial on the that will be held on . (date of hearing/trial must be within twelve months of the date of the removal of the child or youth from the home) 2. Permanency Plan Due/Hearing Dates: The Commissioner of Children and Families shall file: A Motion for Review of Permanency Plan on or before: (date) . . A hearing to review said Motion and said Permanency Plan shall be held on: (date) Name of Judge Signed (Judge) Date of Order The above and foregoing is a true copy of the order and was mailed to the Commissioner of Children and Families. Signed (Judge, Assistant Clerk) At (Town) On (Date) JD-JM-129 Rev. 7-15 (Page 2) American LegalNet, Inc. www.FormsWorkFlow.com