TRAVIS COUNTY JUVENILE COURT DOMESTIC RELATIONS OFFICE ESTELA P. MEDINA Chief Juvenile Probation Officer SCOT M. DOYAL Director FRIEND OF THE COURT INTERVENTION SERVICES APPLICATION 1010 Lavaca Street, P.O. Box 1495 Austin, TX 78767 512-854-9924 fax 512-854-9819 Any Non-Custodial and/or Custodial Parent may apply for services as long as the following criteria are met: 1) Must have a final Court Order (this includes Divorce Decrees, Modification Orders, Paternity Decrees or Orders Establishing the Parent-Child Relationship, and Protective Orders) 2) Must be willing to abide by all program rules and recommendations of staff 3) Must be willing to participate in a Conflict Resolution Meeting 4) Must complete all 6 Cooperative Parenting Forums 5) At least one of the parties must reside in Travis or contiguous counties To apply for Intervention Services with the Access and Visitation Program, please complete an application (currently available at the DRO offices and on the DRO website: http://www.co.travis.tx.us/dro/visit.asp). Return the application along with a copy of each pertinent court order. (Once you submit an application you will be scheduled for an appointment.)You will be notified in writing of DRO's acceptance and/or rejection of your case within 5 working days. I certify that I have read, understood and agree to abide by the terms of the criteria for acceptance in the Intervention Services by the Domestic Relations Office Access and Visitation Program ___________________________________ APPLICANT SIGNATURE 1010 LAVACA P.O. BOX 1495 AUSTIN, TEXAS 78767 PHONE: (512) 854-9924 FAX: (512) 854-9819 American LegalNet, Inc. www.FormsWorkFlow.com IMPORTANT INFORMATION PLEASE READ BEFORE YOU PROCEED Intervention Service cases do not qualify for legal intervention through our office. If at any time you feel the only recourse is litigation you will need to Consult and/or hire an attorney to file the appropriate legal documents with the court. In order for us to process your application, we ask that you complete the entire application and acquire and keep in your possession all required documents. Without the required information, we will be unable to process your application. A copy of the most recent court order must be attached to this application. If you do not have one, you may obtain one from the District Clerks Office in the County your order was issued 2 American LegalNet, Inc. www.FormsWorkFlow.com FRIEND OF THE COURT ACCESS AND VISITATION-INTERVENTION SERVICES CASE HISTORY Name: ____________________________CAUSE#:_____________________DATE:___________________________ 1. Why did you contact us? ________________________________________________________________________ ____________________________________________________________________________________________ 2. 3. 4. Are you a Custodial Parent? YES NO Do you have a final Travis County Court Order? YES NO If no what County/State ____________________ Do you have an attorney or agency helping you with your visitation case? YES NO If yes, list the name, address and phone number of the attorney or agency ____________________________________________________________________________________________ What is the visitation schedule outlined in your order? 1st,,3rd and 5th weekend starting at 6:00 pm on Friday through 6:00 pm Sunday 2nd and 4th weekend starting at 6:00 pm Friday through 6:00 pm Sunday Other I don't know 5. 6. Have you made any "out-of-court" agreements with the other parent in regard to visitation with your children? YES NO If yes, please explain _______________________________________________________________ ____________________________________________________________________________________________ 7. Has the other parent given you any reason or excuse why the visitation schedule outlined in your order is not being followed? YES NO If yes, please explain ________________________________________________ _____________________________________________________________________________________________ 8. How long ago was the last visit with your child(ren) 1 week or less 1 month or less 6 months or less 1 year or less More than 1 year Never had any visits 9. Have the police been called during exchanges? YES NO If yes, please explain ________________________ ____________________________________________________________________________________________ 3 American LegalNet, Inc. www.FormsWorkFlow.com 10. Has the other parent ever alleged he/she is afraid of you? YES NO If yes, please explain ________________ ____________________________________________________________________________________________ 11. Has there ever been a physical altercation between you and the other parent. YES NO If yes, please explain __________________________________________________________________________ _____________________________________________________________________________________________ 12. Is there now or has there ever been a restraining order, protective order, or trespass warrant in effect against you, the other parent or anyone else in either household? YES NO If yes, please explain ____________________ ____________________________________________________________________________________________ 13. Has Child Protective Services ever contacted you or the other parent? YES NO If yes, please explain ____________________________________________________________________________________________ ____________________________________________________________________________________________ 14. Have you ever been accused, charged or convicted of sexual assault, indecency, injury or endangerment of a child? YES NO If yes, please explain ________________________________________________________ ____________________________________________________________________________________________ 15. How long have you lived at your current address? Less than 6 months 6 months ­ 1 year More than 1 year 16. Are you currently in a relationship? YES NO If yes, how does the other party get along with your current Partner? Ok Does not like my current partner Likes my partner Does not want my partner to be around our child(ren) Does not know my partner 17. How does your child get along with your current partner? Ok Does not like my current partner Likes my partner Does not want to be around my partner Does not know my partner 4 American LegalNet, Inc. www.FormsWorkFlow.com 18. Has there ever been a physical altercation between you and your current partner? YES NO If