IW-1790, 09/16 Order for Change in Placement (Out-of-Home to Out-of-Home Placement Only) Indian Child Welfare Act 24724748.357 and 938.357, Wisconsin Statutes; 25 U.S.C. 2472471912, 1915. 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 Order for Change in Placement ( Out - of - Home to Out - of - Home Placement Only) Indian Child Welfare Act Case No. THE COURT FINDS: 1. The child/juvenile is currently under a temporary physical custody order. dispositional order. 2. A Notice of C hange in P lacement was filed and no objection to the change in placement was received. 3. A request for a hearing on change in placement was filed and the hearing was held on [ Date] . As to the department 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. 4. The child/juvenile is subject to th e 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. Specify: 5. Reasonable efforts to place the child/juvenile in a placement that enables the sibling group to r emain together were made. 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. THE COURT ORDERS: 1. The placement of the child/juvenile is changed to remains at American LegalNet, Inc. www.FormsWorkFlow.com IW-1790, 09/16 Order for Change in Placement (Out-of-Home to Out-of-Home Placement Only) Indian Child Welfare Act 24724748.357 and 938.357, Wisconsin Statutes; 25 U.S.C. 2472471912, 1915. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 and placement and care responsibility continues with the department in the county where this order is issu ed, or the Division of Milwaukee Child Protective Services if this order is issued in Milwaukee County under Ch. 48, which continues to have primary responsibility for providing services . 2. Transportation to the new placement shall be provided by . 3. The child/juvenile has one or more siblings in out - of - home care and the child/juvenile 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/juvenile and any siblings. The department or agency 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/juvenile or any siblings. 4. Al l provisions of the temporary physical custody or dispositional order not changed herein remain in full force and effect. 5. The parent(s) who appeared in court have been orally advised of the applicable grounds for termination of parental rights (TPR) and the conditions that are necessary for a safe return to the home or a restoration of visitation rights. Written TPR Warnings are attached. Conditions for return/visitation are part of this order or attached. 6. The parent(s) shall contribute toward the expenses of custody/services in the amount of $ . to be determined by [ Agency ] . 7. 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. 8. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. DISTRIBUTION: 1. Court 2. Child/Juvenile/Attorney/Guardian ad Litem 3. Parents/Guardian/Indian Custodian 4. Legal and/or Physical Custodian/Attorney (if any) 5. Case Worker 6. Foster Parent/Treatment Foster Parent (if any) 7. District Attorney/Corporation Counsel 8. Tribe 9. Other: American LegalNet, Inc. www.FormsWorkFlow.com