TRAVIS COUNTY JUVENILE COURT DOMESTIC RELATIONS OFFICE ESTELA P. MEDINA Chief Juvenile Probation Officer SCOT M. DOYAL Director Travis County Domestic Relations Office Visitation and Cooperative Parenting Program Application 1010 Lavaca Street, P.O. Box 1495 Austin, TX 78767 512-854-9821 fax 512-854-9819 CRITERIA FOR ACCEPTANCE OF AN ENFORCEMENT CASE BY THE DRO THE DOMESTIC RELATIONS OFFICE (DRO) REPRESENTS ONLY THE INTERESTS OF THE COURT THAT RENDERED THE ORDER AS THE “FRIEND OF THE COURT.”,THE OFFICE REPRESENTS NEITHER THE APPLICANT NOR THE RESPONDING PARTY. BOTH PARTIES HAVE THE RIGHT TO HIRE AN ATTORNEY TO REPRESENT THEM IN ANY COURT ACTION THAT MAY BE TAKEN BY THE DOMESTIC RELATIONS OFFICE. ANY NON-CUSTODIAL PARENT MAY APPLY FOR SERVICES AS LONG AS THE FOLLOWING CRITERIA ARE MET: 1) The order to be enforced was issued by a Travis County Court, or has already been transferred to Travis County if it was originally issued by a court outside of Travis County; 2) Must have a final Travis County Court Order (this includes Divorce Decrees, Modification Orders, Paternity Decrees or Orders Establishing the Parent-Child Relationship, and Protective Orders) 3) There is no litigation pending; 4) Must have at least 3 documented denials of visitation To apply for 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/enforce_visit.asp) Return the application to DRO along with a copy of each pertinent court order. Once you submit an application you will be scheduled for an intake interview. You will be notified in writing of DRO’s acceptance and/or rejection of your case within 5 working days after the intake interview is completed. NOTICE: If the respondent lives out of town, the applicant will be required to pay the costs of serving the other parent (usually about $150.00, but it varies with location). If the applicant lives out of town, and the case is set for court, he/she will be required to attend a hearing or hearings in Travis County. I certify that I have read, understood and agree to abide by the terms of the criteria for acceptance of an enforcement case by the DRO. ___________________________________ APPLICANT SIGNATURE 1010 LAVACA P.O. BOX 1495 AUSTIN, TEXAS 78767 PHONE: (512) 854-9821 FAX: (512) 854-9819 American LegalNet, Inc. www.FormsWorkFlow.com GENERAL INFORMATION 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. PRIVACY ACT NOTICE: Disclosure of your social security number, and the social security numbers of your children, is required by Section 105.006, Texas Family Code. Failure to disclose this information may result in the denial of legal services. The Legal Enforcement Division will use these social security numbers for the purpose of enforcing visitation for you. 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 Clerk, 3RD floor, Travis County Courthouse, 1000 Guadalupe, Austin, Texas 78701. It is the policy of this office to attempt to resolve disputes involving possession by sending both parties through access facilitation and cooperative parenting classes. The person with primary possession may be sent a complaint letter. The letter advises the person with primary possession that a complaint has been received by the Domestic Relations Office that the possession schedule is not being followed as ordered; and unless the problem is solved, legal action may be taken. Every reasonable effort will be made to resolve the possession dispute without court action. Both parties are required to participate in a Conflict Resolution Meeting and cooperative parenting classes if applicable. If warranted, referral to monitored exchanges or supervised visitation may be recommended. By applying for services through the Travis County Domestic Relations Office, you are agreeing to participate in all activities recommended by the Travis County DRO staff. INFORMATION ABOUT PARTIES – (PLEASE PRINT) APPLICANT INFORMATION – POSSESSORY CONSERVATOR _______ or JOINT M/C ______ Your full legal name: ____________________________________________________________________________________________________ Last First Middle Your home address: ___________________________________________________________________________________________________ Street Apt. # City Zip Your telephone number: ( ) ( ) ________ ( ) _________________________ Home Cell Work Please provide the following information about yourself: Date of Birth Social Security Number Drive License or ID Number Sex (include state) M or F Email address__________________________________ other contact information__________________________________________________ Have you ever been arrested? □ YES □ NO If yes, for what offense: ____________________________________________________________ Have you ever been in jail or prison? □ YES □ NO If yes, Date _______________________ Release Date_________________________ Have you ever been on probation, parole or received deferred adjudication? □ YES □ NO If yes, please provide: Offense Term of Probation/Parole Parole/Probation Officer Name Date completed: Phone # ( ) Address Have you used or are you currently using illegal drugs? □ YES □ NO If yes, please explain: _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Do you have any outstanding warrants for your arrest? □ YES □ NO If yes, What County/State? ________________________________ for what offense? ___________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 2 INFORMATION ON PERSON WITH PRIMARY POSSESSION OF CHILD: Full legal name: ______________________________________________________________________________________________________ Last First Middle Current home address: ________________________________________________________________________________________________ Street Apt. # City Zip OR Last known home address: _____________________________________________________________________________________________ Street Apt. # City Zip Telephone number: (______)____________________(_______)_______________(_______)________________________________________ Home Cell Work Date of Birth Birthplace (City and State) Social Security Number Driver License or ID number (include state) Sex Race Height Hair Color Eye Color Weight List any physical or mental impairments, medical problems, etc. List identifying information (for example: glasses, scars, tattoos, marks, etc.) Email address________________________________________ other contact information__________________________________________ Does He/She have an account on a social network site (i.e. facebook, MySpace etc.) □ YES □ NO If yes please provide detailed information _____________________________________________________________________________________________________________________ Employer Address: Phone # Employment Position: Work Hours: VEHICLE INFORMATION Automobile Make: __________________________________ Model: __________________________________Year:____________________ Color: ____________________ Tag No. _______________________Other Information: __________________________________________ Additional information/other locations where service may be attempted: ______________________________________________________ ____________________________________________________________________________________________________________________ Marital status: Is the other parent currently married? □ YES □ NO Please name all individuals who live with the other parent and identify their relationship_____________________________ _________________________________________________________________________________________________________ Provide any information about the other parent’s whereabouts (stays with friends, frequents bars, etc):_________________ _________________________________________________________________________________________________________ Has the other party ever been arrested? □ YES □ NO If yes, for what offense: ___________________________________________________ Has the other party been in jail or prison? □ YES □ NO If yes, Date ______________________Release Date__________________________ Has the other party been on probation, parole or received deferred adjudication? □ YES □ NO If yes, please provide: Offense Term of Probation/Parole Parole/Probation Officer Name Phone # ( ) Date completed: Address Has the other party used or is currently using illegal drugs? □ YES □ NO If yes, please explain: ____________ Does the other party have any outstanding warrants for their arrest? □ YES □ NO If yes, What County/State? _____________________________For what offense? __________________________ Do you have a photograph of the other parent? □ YES □ NO, if yes, please enclose with the application American LegalNet, Inc. www.FormsWorkFlow.com 3 DEMOGRAPHIC INFORMATION How did you find out about this office? □ Self □ Court □ Child Support Office □Domestic Violence Agency □Child Protection Agency □ other What is your relationship to these children? □ Father □ Mother □ Grandparent □Legal Guardian □ Other How many children are involved in this case? _______________ At the time that the children involved in this case were born you were: □ Not Married to the other Parent □ Married to the other Parent □ Separated from the other Parent □ Divorced from the other Parent Are you currently married? YES □ NO If yes, do you have children from this marriage? □ YES □ NO If yes, how many children do you have from your current marriage (do not include step-children) __________ How many other children are you responsible for? (does not include stepchildren or children with your new partner) _________________ ETHNICITY □ AMERICAN INDIAN /ALASKA NATIVE □ ASIAN AMERICAN / PACIFIC ISLANDERS □ BLACK/AFRICAN AMERICAN □ WHITE □ HISPANIC □ MULTI-ETHNIC INCOME (IN THOUSANDS) □ LESS THAN $10,000 □ $10,000 – 19,000 □ $20,000 – 29,000 □ $30,000 – 39,000 □ $40,000 AND ABOVE INFORMATION ABOUT THE CHILDREN List the children with whom you have visitation rights that you are attempting to enforce: Name: ________________________________________________ Address: _______________________________________________ Date of Birth: _________________ Sex: ______________________ Name: __________________________________________________ Address: _______________________________________________ Date of Birth: _________________ Sex: ______________________ Name: __________________________________________________ Address: ________________________________________________ Date of Birth: _________________ Sex: ______________________ Name: __________________________________________________ Address: ________________________________________________ Date of Birth: _________________ Sex: ______________________ American LegalNet, Inc. www.FormsWorkFlow.com 4 COURT-ORDERED POSSESSION INFORMATION Name of final order in which current possession was established - DO NOT INCLUDE TEMPORARY ORDERS _____________________________________________________________________________________________________________________ Date order was signed: ___________________________ Is the order a Travis County order? ______________________________________ Is the person with primary possession currently/or previously been placed on probation in Travis or another County for failure to allow possession? □ YES □ NO If yes, please provide detailed information____________________________________________________________ _____________________________________________________________________________________________________________________ List at least three dates that an attempt to visit was denied. These dates must match with dates on which you are entitled to possession of the children according to the last court order regarding possession. 1. ___________________________________________________________________________________________________________________ (Month/Date/Year) (Day of week) (Hour) Address of exchange: _________________________________________________________________________________________________ Street Apt. # City State Zip 2. ___________________________________________________________________________________________________________________ (Month/Date/Year) (Day of Week) (Hour) Address of exchange: _________________________________________________________________________________________________ Street Apt. # City State Zip 3. ___________________________________________________________________________________________________________________ (Month/Date/Year) (Day of Week) (Hour) Address of exchange: _________________________________________________________________________________________________ Street Apt. # City State Zip For any additional dates, include this information on a separate sheet of paper and attach it to your application. Has Child Protective Services (CPS) or any law enforcement authority contacted you with regard to the child(ren)? □ yes □ no if yes please provide detailed information________________________________________________________________________________________ _______________________________________________________________________________________ At any time when you have been denied possession have the police been involved? If so, list the date and case number if any, and describe the action taken by the police in that instance, if any________________________________________________________________________ _____________________________________________________________________________________________________________________ I swear or affirm that I have read the entire application, I understand the information contained therein, and the information I have written on this application is true and correct to the best of my belief and knowledge, and I agree with the terms set forth above. ______________________________________________ APPLICANT SIGNATURE For office use only Services provided by DRO: Parenting time increased? □ Yes □ No ______________________________________ DATE SIGNED □ Mediation □ Counseling / Access Facilitation □ Parenting Plan □ Education / Cooperative Parenting Classes Intake Interview Date _______________________ □ Guidelines/Ct order □ Monitored visit □ Supervised visit □ Neutral drop-off □ Pre-trial conference Date referred for Court: ______________________ American LegalNet, Inc. www.FormsWorkFlow.com 5