State of Minnesota County District Court Judicial District: Court File Number: Case Type: Juvenile In the Matter of the Welfare of the Children of: Parent Parent Date of Report: Date of Hearing: Type of Hearing: GUARDIAN AD LITEM APPOINTMENT On , the Court issued an order requesting the guardian ad litem program to recommend a guardian ad litem to advocate for the best interests of the child(ren) named below. On , the undersigned individual was appointed as the guardian ad litem for the child(ren). IDENTIFYING INFORMATION Mother: Father: Father: Legal Custodian: Child(ren): Child's Name Legal Custodian Legal Custodian Guardian Ad Litem Juvenile Court Report DOB Age (at time of report) Father's Last Name OUT-OF-HOME PLACEMENT INFORMATION The child is in court-ordered out-of-home placement: YES NO If YES, total number of days child has been in court-ordered out-of-home placement: If YES, date by which permanent placement determination hearing must be commenced: CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com INDIAN CHILD WELFARE ACT The Indian Child Welfare Act applies to the child(ren) in this case: If YES, list the name(s) of the child(ren) to whom the Act applies: YES NO REASON FOR COURT INVOLVEMENT Following is a brief summary of the issues that brought the child and family into the court system: COURT HISTORY Following is a summary of the Court's involvement in this case, any prior child protection cases, and any related family court, criminal court, or other court cases, up to the date of this report: Date Court Hearing or Other Event Court File No. (If other than juvenile court file) CONTACT WITH CHILD(REN) SINCE LAST HEARING Since the date of the last hearing, if any, I have had the following contact with the child(ren): Date of Child Contacted Type of Contact (In-person, Phone, Other) Contact CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com PERSONS AND OTHER RESOURCES CONTACTED SINCE LAST HEARING Since the date of the last hearing, if any, the following persons and/or other resources have been contacted by the guardian ad litem in an effort to learn information about the child(ren)'s and families' circumstances and progress: Date of Person or Resource Contacted Title or Agency Name Contact DOCUMENTS REVIEWED SINCE LAST HEARING Since the date of the last hearing, if any, the following documents have been reviewed and relied upon by the guardian ad litem when preparing this report: Date of Document Document Type/Title RELATIVE SEARCH The responsible social services agency has conducted a relative search regarding the child(ren) in this case: YES NO The following information is available about relatives available to serve as resources for the child(ren) and family: CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com SUMMARY OF INFORMATION AND CONCERNS Based upon my contact with the children, contact with others, and review of documents since the date of the last hearing, if any, following is a summary of the relevant information and concern's about the child(ren)'s or family's situation: RECOMMENDATIONS Based upon my contact with the children, contact with others, and review of documents since the date of the last hearing, if any, and based upon all the files and records related to this matter, the best interests of the child(ren) will be served if the Court adopts the following recommendation(s): AMENDMENT OF REPORT As permitted under Rule 38.05, subd. 1, of the Rules of Juvenile Protection Procedure, the guardian ad litem reserves the right to amend and/or supplement this report as deemed necessary or appropriate by the guardian ad litem. Such amendment or supplementation may be done through a written addendum if time permits or, if time does not permit, orally at the time of the hearing. OBJECTION TO REPORT Pursuant to Rule 38.05, subd. 4, of the Rules of Juvenile Protection Procedure, any party who objects to the content or recommendations of this report may submit to the court and other parties a written objection either before or at the hearing at which the report is to be considered. Such objection shall include a statement certifying the content of the objection as true based upon personal observation, first-hand knowledge, or information and belief. An objection may be stated on the record as long as the Court gives the guardian ad litem a reasonable opportunity to respond to the objection. BY SIGNING THIS REPORT I CERTIFY THAT THE CONTENT IS TRUE AND CORRECT BASED UPON PERSONAL OBSERVATION, FIRST-HAND KNOWLEDGE, OR INFORMATION AND BELIEF. Dated: , Guardian Ad Litem cc: , County Court Administration (original report) , Assistant County Attorney , Services Social Worker , Attorney for Mother , Attorney for Father , Attorney for Child(ren) , Attorney for Tribal Representative , Other: , Other: CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com