F.C.A. §§ 661; S.C.P.A. §§ 1706, 1726 Form 6-3 (Guardianship ­ Consent of Person Over 18 and Preference of Person Over 14 Regarding Appointment of Guardian) FAMILY COURT OF THE STATE OF NEW YORK 4/2011 COUNTY OF ............................................................................................... Proceedings for the Appointment of a Docket No. Guardian of the Person Family File No. Standby Guardian CONSENT OF PERSON Permanent Guardian OVER 18 YEARS OF AGE Kinship Guardian PREFERENCE OF MINOR (subsidized kinship guardian program) OVER 14 YEARS OF AGE REGARDING APPOINTMENT OF GUARDIAN of A Person Under the Age of 21 ........................................................................................... State of New York County of : : ss.: : I am the person under the age of 21 who is the subject of this proceeding. I was born on [specify date and year of birth]: [Check applicable box(es)]: I am over the age of 18, I have read the petition and believe it to be true and I consent to the appointment of [specify name of proposed guardian]: as the: Guardian of my Person Standby Guardian Permanent Guardian Kinship Guardian (subsidized kinship guardian program)1 until I reach the age of 21. I am over the age of 14 and under the age of 18, I have read the petition and believe it to be true, and I [check applicable box]: join in oppose do not have a preference regarding the request for the appointment [specify name of proposed guardian]: as the: Guardian of my Person Standby Guardian Permanent Guardian Kinship Guardian (subsidized kinship guardian program). _______________________________ Sworn to this __ day of , ___________________________ (Deputy Clerk of the Court) (Notary Public) ______________________________ Signature of Subject of Proceeding Print or type name Signature of Attorney, if any Attorney's Name (Print or Type) Attorney's Address and Telephone Number W hile the appointment of the guardian continues until I reach the age of 21, I understand that payments under the subsidized kinship guardian program will only continue if the application for payments was made after my 16th birthday AND the social services district determines that: (i) I am completing secondary education or a program leading to an equivalent credential; (ii) I am enrolled in an institution providing post-secondary or vocational education; (iii) I am employed for at least eighty hours per month; (iv) I am participating in a program or activity designed to promote, or remove barriers to, employment; or (v) I am incapable of any of the above activities due to a medical condition regularly documented in my case plan. American LegalNet, Inc. www.FormsWorkFlow.com 1