IW-1754, 09/16 Notice of Change in Placement (Out-of-Home to Out-of-Home/Out-of-Home to In-Home/In-Home to In-Home) Indian Child Welfare Act 24724748.357 and 938.357, Wisconsin Statutes; 25 U.S.C. 2471915. This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Notice of Change in Placement Out - of - Home to Out - of - Home Out - of - Home to In - Home In - Home to In - Home Indian Child Welfare Act Case No. 1. The child/juvenile is subject to the Indian Child Welfare Act. 2. The child/juvenile is currently under a temporary physical custody order. dispositional order. 3. The placement A. will be changed on [D ate ] , which is at least ten ( 10 ) days after the notice was filed with the court. This change was was not authorized in the temporary physical custody/dispositional order. If you object to the change in placement, a written objection must be filed with the court within ten (10) days after filing of this notice. If you file a written objection, the court will schedule a hearing. Copies of the objection should be sent to all parties. If this change in placement was a uthorized in the current order, your objection must state new information that affects the advisability of the order. Give reason for new placement, why it is preferable and how it satisfies treatment plan ordered by the court: B. was changed on [Date] due to emergency conditions necessitating an immediate change. This notice shall be sent within 48 hours after the emergency change in placement. If you object to the change in placement, a written objection must be filed with the court within ten (10) days after filing of this notice . If you file a written objection , the court will schedule a hearing. Copies of the request for a hearing should be sent to all parties. Give reason for new placement, describe emergency conditions necessitating an immediate change, why it is preferable and how it satisfies treatment plan ordered by the court: 4. Reasonable efforts to place the child/juvenile in a placement that enables the siblin g group to remain together were made by not required because the child/juvenile does not have siblings in out - of - home care. not required because it would be contrary to the safety or well being of the child/juvenile or any of the siblings because 5. Name and address of new placement: American LegalNet, Inc. www.FormsWorkFlow.com IW-1754, 09/16 Notice of Change in Placement (Out-of-Home to Out-of-Home/Out-of-Home to In-Home/In-Home to In-Home) Indian Child Welfare Act 24724748.357 and 938.357, Wisconsin Statutes; 25 U.S.C. 2471915. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 6 . The proposed change in placement would change the placement from a place ment outside the home to another placement outside the home. A . The placement is in accordance with the order of preference set forth in the Indian Child Welfare Act. OR B . There is good cause to depart from the order of placement preference in the Indian Child Welfare Act. Specify: 7 . If placement continues to be outside the home, the parents/guardian/legal custodian/Indian custodian/trustee may be required to pay support for the placement. DISTRIBUTION: 1. Court 2. Child/Juvenile 3. Parents /Guardian/Legal Custodian/Indian Custodian 4. Case Worker/District Attorney/Corporation Counsel 5. Child / GAL 6. Foster Parent/Physical Custodian 6. Tribe 7. Other: Case Worker/District Attorney/Corporation Counsel Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com