Whatcom County Superior Court Guardian ad Litem Information CONTACT INFORMATION LAST NAME FIRST NAME M.I. SSN OR TAX ID# (NOT TO BE SHARED) BUSINESS NAME OR FIRM BUSINESS STREET ADDRESS BUSINESS CITY, STATE, ZIP CODE MAY THE PUBLIC VIEW THIS STREET ADDRESS? YES ALTERNATE PHONE DATE BUSINESS PHONE NO ( FAX ) ( ) ( ) EMAIL ADDRESS MAY THE PUBLIC VIEW THIS EMAIL ADDRESS? YES NO RETAINER AMOUNT COMMENTS HOURLY RATE COMMENTS EDUCATION LEVEL AND LOCATION OF FORMAL EDUCATION (e.g. Master's Degree in Child Psychology from Brown University) CERTIFIED GUARDIAN AD LITEM TRAINING DATE AND TYPE OF INITIAL TRAINING DATE AND TYPE OF ANNUAL REFRESHER TRAINING OTHER FORMAL TRAINING/ CERTIFICATIONS/ LICENSES (INCLUDE DATE AND TYPE) RELEVANT EXPERIENCE LIST EQUIVALENT EXPERIENCE NUMBER OF YEARS AS A GUARDIAN AD LITEM NUMBER OF APPOINTMENTS AS A GUARDIAN AD LITEM LIST ALL COUNTIES OF APPOINTMENT LIST ANY AND ALL CIRCUMSTANCES OF REMOVAL FROM G.A.L. REGISTRY PURSUANT TO A GRIEVANCE ACTION. PROVIDE NAME OF COURT AND THE CASE NUMBER FROM WHICH YOU WERE REMOVED. FOR CRIMINAL HISTORY CHECK PURPOSES, NOT TO BE AVAILABLE TO PUBLIC: Alias/Maiden Name: Date of Birth: Gender: Race: Driver's License Number: Social Security Number: American LegalNet, Inc. www.USCourtForms.com