STATE OF WISCONSIN, CIRCUIT COURT, IN THE INTEREST OF COUNTY For Official Use Dispositional Order Appointing Guardian a person under the age of 18. Case No. Date of Birth THE COURT FINDS: 1. a. The child has no living parent and adoption is is not in the best interests of the child. OR b. The child has living parent(s): (Names) 2. The child has been adjudged to be in need of protection or services under § and has been placed, or continued in placement, outside his or her home pursuant to one or more court orders under § . 3. The person nominated as the guardian of the child is a person with whom the child has been placed and it is likely that the child will continue to be placed with that person for an extended period of time or until the child attains the age of 18. 4. It is likely that the person, if appointed, would be willing and able to serve as the child’s guardian for an extended period of time or until the child attains the age of 18. 5. It is not in the best interests of the child that a petition to terminate parental rights be filed with respect to the child. 6. The parent(s) is/are refusing, neglecting or unable to carry out the duties of a guardian. 7. The agency primarily responsible for providing services to the child under a court order has made reasonable efforts to prevent the removal of the child from his/her home, except when the court is not required to make a reasonable efforts finding as specified in §48.355(2d)(b)1. to 5.,Wis. Stats., while assuring the child’s health and safety, but that continued placement of the child in the home would be contrary to the welfare of the child. 8. The child is is not subject to ch. 822, Wis. Stats. 9. It is is not in the child’s best interests that the person be appointed guardian with: full powers enumerated under §48.023, Wis. Stats. powers limited to: 10. The determinations made under §48.623(1), Wis. Stats., that the guardian is eligible to receive monthly subsidized guardianship payments are confirmed. 11. a. The child is not subject to the federal Indian Child Welfare Act. b. The child is subject to the federal Indian Child Welfare Act, AND placement has been made in accordance with the order of preference set forth in the Indian Child Welfare Act. OR there is good cause to depart from the order of placement preference in the Indian Child Welfare Act: THE COURT ORDERS: The petition is 1. GRANTED and (Name) full powers enumerated under §48.023, Wis. Stats. powers limited to: is appointed guardian with 2. DENIED and this matter is dismissed. THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL. BY THE COURT: Circuit Court Judge DISTRIBUTION: 1. Court - Original 2. Parties 3. Tribe (if any) Name Printed or Typed Date JC-1606, 08/11 Dispositional Order Appointing Guardian §§48.623(1), 48.831 and 48.977, Wisconsin Statutes; 25 U.S.C. §1915. This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com