IW-1611, 11/15 Dispositional Order Protection or Services (Chapter 48) Indian Child Welfare Act 24724748.345, 48.355, 48.356 and 48.78(2)(ag) and (aj), Wisconsin Statutes; 25 U.S.C. 2472471912, 1915 This form shall not be modified. It may be supplemented with additional material. Page 1 of 4 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Dispositional Order Protection or Services (Chapter 48) Indian Child Welfare Act Case No. A P etition has been filed with the court. This dispositional hearing was held on [Date] , which is the effective date of this O rder. THE COURT FINDS: 1. The child is in need of protection or services because: Count Description Wisconsin Statutes Plea Date of Petition 2. The child is subject to the Indian Child Welfare Act. ( If the child is placed in the home and therefore not subject to the Indian Child Welfare Act, use form JC - 16 11 instead of this O rder.) 3. The child is placed out of the home. A. Continued custody of the child by the parent or Indian custodian is is not likely to result in serious emotional or physical damage to the child, based on the testimony of one or more qualified expert witnesses. [This finding is not required if made at a previous hearing in the case.] B. Active efforts were were not made to provide remedial services and rehabilitation programs designed to prevent the brea kup of the Indian family. [This finding is not required if made at a previous hearing in the case.] See attached Statement of Active Efforts (IW - 1609) C. 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. D. Placement in the home at this time is . E. Reasonable efforts to prevent removal were [ Complete one of the following ] American LegalNet, Inc. www.FormsWorkFlow.com IW-1611, 11/15 Dispositional Order Protection or Services (Chapter 48) Indian Child Welfare Act 24724748.345, 48.355, 48.356 and 48.78(2)(ag) and (aj), Wisconsin Statutes; 25 U.S.C. 2472471912, 1915 This form shall not be modified. It may be supplemented with additional material. Page 2 of 4 made by the department or agency responsible for providing services. made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child from the home. not required under 24748.355(2d) , Wis. Stats. required, but the department or agency responsible for providing services failed to make reasonable efforts. F. Reasonable efforts to place the child in a placement that enables the siblin g group to remain together were made. not required because the child does not have siblings in out - of - home care. not required because it would be con trary to the safety or well being of the child or any of the siblings. G. Permanency plan was not filed. filed and reasonable efforts to achieve the permanency goal of the permanency plan, including t hrough an out - of - state placement if appropriate, were [C omplete one of the following only if a permanency plan was filed] made by the department or agency responsible for providing services as follows: not made by the department or agency responsible for providing services. 4 . The mother father was present and was asked to provide the names and other identifying information of three adult rel atives of the child or other adult individuals whose home the parent requests the court to consider as placements for the child, unless that information was previously provided. 5. As to t he depa rtment or agency recommendation: A . The placement location recommended by the department or agency is adopted. OR B . After giving bona fide consideration to the recommendations of the department or agency and all parties, the placement location recommended is not adopted. 6 . The Statement of Guardian ad Litem was filed. 7. Other: THE COURT ORDERS: 1. The child is placed under court jurisdiction. 2 . Placement out - of - home at and into the placement and care responsibility of the department in the county where this order is issued, or the Division of Milwaukee Child Protective Services if this order is issued in Milwaukee County, which has primary responsibility for providing services. Unless otherwise specified, the expiration date of this order shall be the later of the following: One year from the date of this order; The date the child reaches his or her 18 th birthday; The date the child is granted a high school or high school equivalency diploma or the date the child reaches his or her 19 th birthday, whichever occurs first, if the child is enrolled fulltime in a secondary school or vocational or technical eq uivalent and reasonably expected to complete the program prior to age 19; The date the child is granted a high school or high school equivalency diploma or the date the child reaches his or her 21 st birthday, whichever occurs first, if ALL of the following apply: American LegalNet, Inc. www.FormsWorkFlow.com IW-1611, 11/15 Dispositional Order Protection or Services (Chapter 48) Indian Child Welfare Act 24724748.345, 48.355, 48.356 and 48.78(2)(ag) and (aj), Wisconsin Statutes; 25 U.S.C. 2472471912, 1915 This form shall not be modified. It may be supplemented with additional material. Page 3 of 4 The child is a fulltime student in secondary school or vocational or technical equivalent. An individualized education program is in effect for the child. The child or guardian, on behalf of the child, agrees to this order. The child is 17 years of age or older when this order is entered. OR Expiration date of this O rder . 3. The child has one or more siblings in out - of - home care and the child is not placed with all those siblings. The department or agency shall make reasonable efforts to provide frequent visitation or other ongoing interaction between the child and any siblings. is not required to provide for frequent visitation or other ongoing interaction because it would be contrary to the safety or well being of the child or any siblings. 4. The department or agency shall conduct a diligent search in order to l ocate and provide notice as required by 24748.355(2)(cm), Wis. Stats., to all adult relatives of the child, including the three adult relatives provided by the parents under 24748.335(6), Wis. Stats., no later than 30 days from the date of the child removal from the home, unless the search was previously conducted and notice provided. 5. If a permanency plan has been prepared, filed and is consistent with this order, this order contains the plan. e home and shall be made part of this O rder. 6. Conditions of supervision and/or return as follows: See attached 7. Specific services to be provided to child and family as follows: See attached 8. Legal custody transferred to County Department of Human/Social Services. Wisconsin Department of Children and Families. Division of Milwaukee Child Protective Services. Other: 9. Special treatment or care as follows: See attached 10. If the child is placed outside of the home, the parent(s) shall provide a statement of income, assets, debts, and living expenses to the county department or agency. A. The parent(s)/guardian shall contribute toward the expenses of custody/services in the amount of $ . to be determined by [Agency] . B. The amount of support to be paid by the parent(s), guardian or trustee for the out - of - home placement is $ or % of gross income payable by wage assessment. to be set by the child support agency. The support obligation begins on the date of placement. 11. The appointment of the guardian ad litem for the child terminates until further order of the court. is continued to allow the guardian ad litem to perform any of the duties und er 24748.235(4), Wis. Stats. is continued for the following purpose(s): 12. The appointment of the attorney for the mother father other: terminates until f urther order of the court. mother father other: is continued through the term of this order. American LegalNet, Inc. www.FormsWorkFlow.com IW-1611, 11/15 Dispositional Order Protection or Services (Chapter 4