Commonwealth of Pennsylvania In the Interest Of: ____________________ IN THE COURT OF COMMON PLEAS OF ____________________ COUNTY PENNSYLVANIA JUVENILE DIVISION Date of Birth ______________ DOCKET NO: _____________________ FID: _____________________ MOTION FOR RESUMPTION OF JURISDICTION , avers that the above-captioned child is under twenty-one years of age, was adjudicated dependent prior to turning eighteen years of age, has requested the court to resume jurisdiction and meets the following criteria for resumption of dependency jurisdiction: 1. Dependency jurisdiction was previously terminated on days prior to, or on or after the child's eighteenth birthday; and , which was within 90 2. The child is: (I) completing secondary education or an equivalent credential; (II) enrolled in an institution which provides post-secondary or vocational education; (III) participating in a program actively designed to promote or remove barriers to employment; (IV) employed for at least 80 hours per month; or (V) incapable of doing any of the activities described in subparagraph (I), (II), (III) or (IV) due to a medical or behavioral health condition, which is supported by regularly updated information in the permanency plan of the child. 3. The child would like his or her parent, guardian or other interested adult involved in the court proceedings. Specifically, 4. 5. The child has signed a verification that the above requirements have been met. An expedited hearing for placement and services is requested due to the child's current living arrangement. WHEREFORE, the movant requests the Court to issue an order granting resumption of dependency jurisdiction over the child and any other relief the Court may deem proper and reasonable under the circumstances. Date: __________ __________________________ Movant's Signature _________________________ Printed Name Address: Phone: AOPC Form Updated 07/25/2013 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com