IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT IN AND FOR ___________________ COUNTY, FLORIDA JUVENILE DIVISION In the Interest of a child children ) ) ) ) ) Case No. ORDER ON JUDICIAL REVIEW FOR CHILD AGE 17 OR OLDER THIS CAUSE came on to be heard on , 20 for Judicial Review on the report filed by the Department of Children and Family Services., under Florida Statutes, chapter 39. The following persons appeared before the court: (check appropriate box and list corresponding name) , Child(ren) , Attorney/Attorney ad litem for the child(ren) , Petitioner , Attorney for Petitioner , Attorney for Petitioner , Attorney for department , Department caseworker , Mother , Attorney for Mother , Father of (child(ren):) , Attorney for Father , Guardian ad litem , Attorney for guardian ad litem , Legal custodian , Attorney for legal custodian , Other: and the court having considered Judicial Review Social Study Report filed by the Department; If the child(ren) has (have) reached the age of 17, written verification that the child(ren): Has (have) been provided with a current Medicaid card and all necessary information concerning the Medicaid program; Has (have) been provided with a certified copy of his/her/their birth certificate; Has (have) a valid Florida driver’s license(s) or has (have) been provided with a Florida identification card(s); Has (have) been provided information relating to Social Security Insurance benefits, if the child(ren) is (are) believed to be eligible; Has (have) received a full accounting if there is a Master Trust for the child(ren); Has (have) been provided with information and training related to budgeting, interviewing, and parenting skills; Order On Judicial Review For Child Age 17 Or Older {8.973} Page 1 of 6 American LegalNet, Inc. www.USCourtForms.com Has (have) been provided with information related to the Road-to-Independence Scholarship, including applications forms; Has (have) been informed that if he/she/they is/are eligible for the Road-to-Independence Scholarship program, he/she/they may reside with the licensed foster family or group care provider with whom the child(ren) was (were) residing at the time of attaining his/her/their 18th birthday or may reside in another licensed foster home or with a group care provider arranged by the department; Has (have) an open bank account(s) and has been provided with banking skills; Has (have) been provided with information on public assistance and how to apply; Has (have) been provided a clear understanding of where he/she/they will be living on his/her/their 18th birthday, how living expenses will be paid, and what educational program the child(ren) will be enrolled in; Has (have) been provided with notice of his/her/their right to petition for the court’s continuing jurisdiction for one year after his/her/their 18th birthday, and with information on how to obtain access to the court; and Has (have) been encouraged to attend all judicial review hearings occurring after his/her/their 17th birthday. Statement/homestudy filed by the Department; Report of the Guardian Ad Litem; A case plan, dated , 20 , filed by the Department, that includes information related to independent living services that have been provided since the child(ren)’s 13th birthday or since the date the child(ren) came into foster care, whichever came later; Statement by the child(ren)’s caretaker; Whether or not the child(ren) is/are (a) citizen(s) and, if the child(ren) is/are not (a) citizen(s), the steps that have been taken to address the citizenship or residency status of the child(ren); Other: AND THE COURT having heard testimony and argument, and having been otherwise duly advised in the premises finds: 1. That the minor child(ren) who is/are the subject matter of these proceedings, was/were adjudicated dependent, continue to be dependent, is/are of an age subject to the jurisdiction of the court, and is/are resident(s) of the state of Florida. 2. The following parties were notified of this hearing and provided a copy of the documents filed for this hearing: (check appropriate box and list corresponding name) , Child(ren) , Attorney/Attorney ad litem for the child(ren) , Petitioner , Attorney for Petitioner , Attorney for department , Department caseworker , Mother , Attorney for Mother , Father of (child:) , Attorney for Father , Guardian ad litem , Attorney for guardian ad litem , Legal custodian , Attorney for legal custodian , Other: 3. The child(ren) has (have) been given the opportunity to address the court with any information relevant to the child(ren)’s best interests. Order On Judicial Review For Child Age 17 Or Older {8.973} Page 2 of 6 American LegalNet, Inc. www.USCourtForms.com 4. The mother, (name) did not appear, and appeared with : was was not represented by counsel; without counsel and: knowingly, intelligently, and voluntarily was was not advised of her right to legal counsel; waived did not waive her right to legal counsel; and was was not determined to qualify as indigent and was was not appointed an attorney. 5. The father, (name) did not appear, and appeared with : was was not represented by counsel; without counsel and: knowingly, intelligently, and voluntarily was was not advised of his right to legal counsel; waived did not waive his right to legal counsel; and was was not determined to qualify as indigent and was was not appointed an attorney. 6. The father, (name) did not appear, and appeared with : was was not represented by counsel; without counsel and: knowingly, intelligently, and voluntarily was was not advised of his right to legal counsel; waived did not waive his right to legal counsel; and was was not determined to qualify as indigent and was was not appointed an attorney. 7. The department filed a judicial review report with the court on is is not in compliance with the statutory requirements. report , 20 . This judicial review 8. The following parents/legal custodians were notified of their right to participate in the preparation of the case plan and to receive assistance from any other person in the preparation of the case plan: 9. The mother has complied with the following tasks in the case plan: 10. The mother has not complied with the following tasks in the case plan: Order On Judicial Review For Child Age 17 Or Older {8.973} Page 3 of 6 American LegalNet, Inc. www.USCourtForms.com 11. The father, (father’s name) tasks in the case plan: , has complied with the following 12. The father, (father’s name) tasks in the case plan: , has not complied with the following 13. The mother has has not complied with court ordered visitation as follows: 14. The father, (father’s name) court ordered visitation as follows: 15. The department 16. The mother has has has has not complied with has not complied with court ordered financial support for the child as follows: , has has not complied with has not complied with court ordered meetings with the department as follows: 19. The father, (father’s name) court ordered meetings with the department as follows: 20. The department has has not complied with court ordered visitation as follows: 17. The father, (father’s name) court ordered financial support for the child as follows: 18. The mother , has , has has not complied with has not complied with court ordered meetings with the parents as follows: Order On Judicial Review For Child Age 17 Or Older {8.973} Page 4 of 6 American LegalNet, Inc. www.USCourtForms.com 21*. It is in the best interest of the minor child(ren) to be placed in the care and custody of: 22*. Placement of the minor child(ren) in the care and custody of is in a setting which is as family like and as close to the home as possible, consistent with the child(ren)’s best interests and special needs. 23*. Return of the minor child(ren) to the custody of be contrary to the best interest and welfare of the minor child(ren). The child(ren) cannot safely home with services and removal of the child(ren) is necessary to protect the child(ren). 24*. Prevention or reunification services were not indicated. remain would be return were indicated and are as follows: . Further efforts could not have shortened separation of this family because: 25**. The child(ren) can safely remain with be returned to (parent(s)) as long as he/she/they comply(ies) with the following: . The safety, well-being, and physical, mental, and emotional health of the child(ren) are not endangered by allowing the child(ren) to remain return home. 26. The child’s petition and application for special immigrant juvenile status or other immigration decision remains pending. 27. The department has has not complied with its obligation as specified in the written case plan or in the provision of independent living services as required by Florida Statutes. THEREFORE, based upon the foregoing findings, it is hereby ORDERED AND ADJUDGED that: 1. The minor child(ren), be placed in the custody of , , under supervision of the department. 2. The judicial review report filed by the department is: not accepted and a continuance was requested. accepted by the court. 3. Other: 4. All prior orders not inconsistent with the present order shall remain in full force and effect. * For use if child(ren is./are not placed in the home of a parent. ** For use if child(ren) remain(s) or is/are returned to the parent(s). Order On Judicial Review For Child Age 17 Or Older {8.973} Page 5 of 6 American LegalNet, Inc. www.USCourtForms.com 5. This court shall retain jurisdiction over this cause to enter any such further orders as may be deemed necessary for the best interest and welfare of the minor child(ren). 6. This court shall retain jurisdiction until the final decision is rendered upon the immigrant child’s 22nd birthday, whichever shall first occur. 7. This court shall retain jurisdiction until the child’s 19th birthday for the purpose of determining whether appropriate aftercare support, Road-to-Independence Scholarship, transitional support, mental health, and developmental disability services have been provided to the youth. 8. This matter is scheduled for Judicial Review on DONE AND ORDERED in , 20 , at , Florida, on .m. , 20 . ____________________________________ Circuit Judge NOTICE OF HEARING The Juvenile Court hereby gives notice of hearing in the above-styled cause before (judge) , at (location) , on , 20 , at .m., or as soon thereafter as counsel can be heard. In accordance with the Americans with Disabilities Act, persons needing a special accommodation to participate in this proceeding should contact the Office of the Court Administrator no later than 7 days before the proceeding at (telephone number) . PLEASE BE GOVERNED ACCORDINGLY. Copies furnished to: Order On Judicial Review For Child Age 17 Or Older {8.973} Page 6 of 6 American LegalNet, Inc. www.USCourtForms.com