COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. SOCIAL HISTORY FORMAT Plaintiff(s) : JUDICIAL SUBPOENA IN THE JUVENILE COURT OF ______________________________ -against: COUNTY, GEORGIA : Child's Name: ______________________________ Court Officer: ______________________________ DOB _________________ : Defendant(s) : . .I. . . . . . OFFENSE. DATA:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... ...... A. Prior Offenses Discuss previous contacts with the Juvenile Court in this county as well as any THE PEOPLE OF THE STATE OF NEW YORK contacts with courts in other counties. B. Current Offense TO List the current complaint which brings the child before the Court and discuss any relative information which would shed light on the circumstances surrounding the offense. GREETINGS: II. FAMILY DATA: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court Describe the family constellation in whichthe child is living. Which family members are located County ofregularly in the household? at in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date,Father - Absent orevidence as a witness inIs there a stepfather? of the to testify and give present in the home? this action on the part Explain and define A. roles. Describe either or both along the following dimensions: (a) role in the homerelationship with spouse, type and consistency of discipline (b) to comply with this of job, income, hours worked (c) role in community. Are Your failure employment - type subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued medical, emotional, drug/alcohol? all damages sustained as a there any outstanding problems: for a maximum penalty of $50 and result of your failure to comply. B. Mother/Stepmother or Other Female Care-taker - Define roles. Describe either or both along the same dimensions as father above. Witness, Honorable , one C. Other Significant Adults - Age, sex, relationship to child. of the Justices of the Court in D. County, day the , 20 Siblings - Are any of of siblings positive resources for the child? Have any been involved with court? E. Home Life - Describe housing, neighborhood. Have there been any traumatic experiences (deaths, illness, divorces, etc.)? Describe basicabove and type name below) (Attorney must sign feelings of family members toward each other (caring, hostile, indifferent). Has the family been referred to or involved in, counseling? F. Discuss how the child perceives the present situation and how the court Attorney(s) for involvement has impacted upon the lives of the family members. Is the child remorseful and willing to face whatever the court decides or is the child hostile and difficult to work with? Will the family resist efforts by the court to help or are they willing to cooperate with the worker? If there hasand P.O. AddressCourt Office been any prior involvement, what was the child and family's reaction to it? Rev. 01/2001 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: JUV-21 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. III. CHILD'S PERSONAL HISTORY AND ADJUSTMENT: Plaintiff(s) : JUDICIAL SUBPOENA A. Physical Health -against: 1. Medical History - Give a general physical description. Discuss in detail any serious illness or handicaps. : 2. Drug/Alcohol Involvement - Is the use/abuse of drugs or alcohol involved in the child's offense(s)? : B. School - Academic and Vocational Aptitude - Discuss school attendance, Defendant(s) : . . . . . . . . . . . . . . .achievement,. .behavior . and . extra. .curricular . activities. Has the child any career .......... ....... ... .... ........ goals, work experience or vocational interests? C. Leisure Time - Has the child any special interest, talents, or activities? D. Treatment Efforts - Has the child been referred to or evaluated by psychologists, THE PEOPLE OF THE STATE OF NEW etc.? Has the child been previously placed in a Youth mental health clinics, YORK Development Center or other DJJ residential program or non-residential program? TO What other agencies are now or have been involved with child? IV. RECOMMENDATIONS: GREETINGS: These should be well thought-out and reasoned recommendations which include WE COMMAND each recommendation. It excuses contain goals and the recommendations before justification for YOU, that all business and should being laid aside, you and each of you attend , the Honorable be the means to achieve those at the If the recommendation is for probation you Court should ends. at County ofshould state what yourlocated are for the child and relate how you intend to help the child goals in room reach those goals. If you recommend restitutionat , on the day of , 20 , you should specify how much, to whom itrecessed o'clock in the noon, and at any or adjourned date,be paid, how give evidence as a witness in this action on the part of the it. (Should the to testify and it should be paid and how the victim should receive should child be required to deliver it in person or pay it into the clerk of the Court?) Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Witness, Honorable Court in County, , one of the Justices of the day of , 20 (Attorney must sign above and type name below) Attorney(s) for Office and P.O. Address Rev. 01/2001 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: JUV-21 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Calendar No. SOCIAL HISTORY FACE SHEET : JUDICIAL SUBPOENA Plaintiff(s) Worker _______________________________________ -against: County ______________________________________ Name ______________________________ Case # _______________________ Date___________ : Address _____________________________________________________________________________ Social Security # _______________ Race / Sex ________ DOB ________ Phone # _________________ : School __________________________________ Phone # ___________________ Grade ____________ Defendant(s) : . . . . . . . . . . . . . . . . . . . . . . . .Father . . . . . . . . . . . Mother . . . . . . . . Other Male ..... ...... Other Female Full Name Address: If different THE PEOPLE OF THE STATE OF NEW YORK from child Marital Status TO Occupation Income Highest Grade GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of Highest before you attend Siblings' Name(s) Age Siblings' Address(es) Marital Occupation , the Honorable at the Court Status Grade located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Has of your failure or psychiatric evaluation been done? Date: / / result a psychologicalto comply. By Whom: ___________________________________ Witness, Honorable , one of the Justices of the Other agencies involved with family: ______________________________________________________ Court in County, day of , 20 Current Offense:_______________________________________________________________________ Informally adjusted or adjudicated offenses (Attorney must sign above and type name below) History of Prior Dispositions Comp. Disposition Date Date Date Disposed Discharged Attorney(s) for Office and P.O. Address Rev. 01/2001 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: JUV-21 American LegalNet, Inc. www.USCourtForms.com