F.C.A.§756-a Form 7-19 (Person in Need of Supervision-Extension of Placement and Permanency Hearing Order) 12/2015 At a term of the Family Court of the State of New York, held in and for the County of , at New York on , . PRESENT Hon. Judge _______________________________________ In the Matter of Docket No. A Person Alleged to be a Person in Need of Supervision, , Respondent ________________________________________ EXTENSION OF PLACEMENT AND PERMANENCY HEARING ORDER DEADLINE: IF THE RESPONDENT REMAINS IN FOSTER CARE, A PETITION FOR THE NEXT PERMANENCY HEARING MUST BE FILED NOT LATER THAN [SPECIFY]:1 ________________________________ . The above-named Respondent having been adjudicated by this Court to be a person in need of supervision within the meaning of Article 7 of the Family Court Act, and an Order of Disposition, dated [specify]: , having been issued placing Respondent with [check applicable box]: a suitable person the Commissioner of Social Services of [specify]: County, And the petition of [specify]: extension of placement and permanency hearing , sworn to on [specify date]: having been filed in this Court [check applicable box]: at least 60 days prior to the expiration of the period of placement; less than 60 days prior to the expiration of the period of placement, , f or an , The petition must be filed at least 60 days prior to the date by which the hearing must be completed. See Uniform Rules of the Family Court, 22 N.Y.C.R.R. §205.17(b). 1 American LegalNet, Inc. www.FormsWorkFlow.com Form 7-19 Page 2 and good cause having [check applicable box] been not been found for the delay; And notice having been duly given to the following person(s), who appeared as follows: [specify; check applicable boxes]: Respondent with counsel without counsel Parent(s)[specify]: Other person(s) legally responsible for Respondent's care [specify]: Prospective adoptive parent(s)[specify]: Foster parent(s)caring for Respondent [specify]: Relative(s) caring for Respondent [specify]: Authorized Agency caring for Respondent [specify]: Other [specify]: And the matter having duly come on to be heard, and the above-named persons appearing having been given an opportunity to be heard, [Required if Respondent is Native-American; check if applicable ]: And the following having been duly notified [check applicable box(es)]: parent/custodian tribe/nation United States Secretary of the Interior; And the tribe/nation having: appeared and participated as a party; appeared and declined to assume jurisdiction; appeared and requested transfer of jurisdiction; not appeared; And the position and information provided by the Commissioner of Social Services of [specify]: County, having been considered by the Court; The Court, after having made an examination and inquiry into the facts and circumstances of the case and into the surroundings, conditions, and capacities of the persons involved, finds and determines the following [Note: judicial findings must be made pursuant to I and II, below]: I. Required "Best Interests" and "Reasonable Efforts" Findings [check applicable boxes and provide case-specific reasons in both A and B below]: A. "Best Interests" Finding: Return of the Respondent to the home would would not be contrary to the Respondent's best interests because [specify facts and reasons]: This determination is based upon the following information [check applicable box(es)]: 9 Extension of Placement and Permanency Petition, dated [specify]: 9 Case Record, dated [specify]: 9 Service Plan, dated [specify]: 9 Probation Department report, dated [specify]: 9 Mental health evaluation, dated [specify]: 9 The report of [specify]: , dated [specify]: 9 Testimony of [specify]: 9 Other [specify]: American LegalNet, Inc. www.FormsWorkFlow.com Form 7-19 Page 3 B. "Reasonable Efforts" Findings: 1. Reasonable efforts, where appropriate, to return the Respondent home safely [check applicable box and state reasons as indicated]: Q were made as follows [specify]: Q were not made but the lack of efforts was appropriate [check all applicable boxes]: because of a prior judicial finding that the authorized agency was not required to make reasonable efforts to reunify the Respondent with the Q parent(s) Q person(s) legally responsible for Respondent's care [specify date of finding]: Q were not made. This determination is based upon the following information [check applicable box(es)]: 9 Extension of Placement and Permanency Petition, dated [specify]: 9 Case Record, dated [specify]: 9 Service Plan, dated [specify]: 9 Probation Department report, dated [specify]: 9 Mental health evaluation, dated [specify]: 9 The report of [specify]: , dated [specify]: 9 Testimony of [specify]: 9 Other [specify]: 2. [Required in cases in which the Respondent's permanency plan is adoption, guardianship or permanent living arrangement other than reunification]: Reasonable efforts to make and finalize the permanency plan of [specify]: Q were made as follows [specify reasonable efforts, including specific documents or evidence supporting findings]: Q were not made. This determination is based upon the following information [check applicable box(es)]: 9 Extension of Placement and Permanency Petition, dated [specify]: 9 Case Record, dated [specify]: 9 Service Plan, dated [specify]: 9 Probation Department report, dated [specify]: 9 Mental health evaluation, dated [specify]: 9 The report of [specify]: , dated [specify]: 9 Testimony of [specify]: 9 Other [specify]: 3. Required for Respondents 16 years of age or older with Alternative Planned American LegalNet, Inc. www.FormsWorkFlow.com Form 7-19 Page 4 Permanent Living Arrangement (APPLA) Goals [check applicable box(es)]: A. Required for Respondents 16 years of age or older with Alternative Planned Permanent Living Arrangement (APPLA) Goals [check applicable box(es)]: 1. Evidence has has not been provided to the Court that a "reasonable and prudent parent" standard of care has been applied to Respondent in the facility or home in which he or she resides; 2. Evidence has has not been provided to the Court that Respondent has been provided with regular, ongoing opportunities to engage in age or developmentally appropriate activities and has been consulted in an age-appropriate manner about the opportunities to participate in such activities; 3. Evidence has has not been provided to the Court, indicating compelling reason(s) that it would not be in the Respondent's best interests to return home, be refe