IW-1789, 09/16 Order for Change in Placement (In-Home to Out-of-Home 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 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Order for Change in Placement (In - Home to Out - of - Home Placement Only) Indian Child Welfare Act Case No. THE COURT FINDS: 1. The child/juvenile is currently under a dispositional order. 2. A R equest for Change in P lacement has been filed. 3. The hearing on the request was held on [Date] , which is the effective date of this O rder. 4 . The allegations of the request are not proven. 5 . The allegations of the request are proven and the court a dopts them as findings of fact. A. The child/juvenile is subject to the Indian Child Welfare Act. B. The child/juvenile is placed out - of - home. 1 ) Continued custody of the child/juvenile by the parent or Indian custodian is is not likely to result in serious emotional or physical damage to the child/juvenile, based on the testimony of one or more qualified expert witnesses. 2 ) Active efforts were were not made to provide remedial services and rehabilitation programs designed to prevent the brea kup of the Indian family. See attached Statement of Active Efforts (IW - 1609) 3 ) 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: 4 ) Placement in - home at this time is 5 ) Reasonable efforts to prevent removal were [Complete one of the following] made by the department or agency responsible for providing services as follows: American LegalNet, Inc. www.FormsWorkFlow.com IW-1789, 09/16 Order for Change in Placement (In-Home to Out-of-Home 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 3 made by the department or agency responsible for providing services, although an emergency situation resulted in immediate removal of the child/juvenile from the home as follows: not required under 24748.355(2d) , Wis. Stats. required, but the department or agency responsible for providing services failed to make reasonable efforts. 6) Reasonable efforts to place the child/juvenile in a placement that enables the sibling group to remain 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. 7 ) 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. 8) The mother father was present and was asked to provide the names and other identifying information of three adult relatives of the child/juvenile or other adult individuals whose home the parent requests the court to consider as placements for the child/juvenile, unless that information w as previously provided. 9) Other: THE COURT ORDERS: The request for change in placement is 1. denied . 2. granted . A. The child/juvenile is placed out - of - home at and into the placement and care responsibility of the depa rtment in the county where this order is issued, or the Division of Milwaukee Child Protective Services if this order is issued in Milwaukee County under Ch. 48, 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 O rder; The date the child/juvenile reaches his or her 18 th birthday; The date the child/juvenile is granted a high school or high school equivalency diploma or the date the child/ juvenile reaches his or her 19 th birthday, whichever occurs first, if the child/juvenile is enrolled fulltime in a secondary school or vocational or technical equivalent and reasonably expected to complete the prog ram prior to age 19; The date the child/j uvenile is granted a high school or high school equivalency diploma or the date the child/juvenile reaches his or her 21 st birthday, whichever occurs first, if ALL of the following apply: The child/juvenile is a fulltime student in secondary school or vocational or technical equivalent. An individualized education program is in effect for the child/juvenile. The child/juvenile or guardian, on behalf of the child/juvenile, agrees to this O rder. The child/juvenile is 17 years of age or older when this order is entered. OR Expiration date of this O rder : . B. Transportation to the new placement shall be provided by . C . 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. American LegalNet, Inc. www.FormsWorkFlow.com IW-1789, 09/16 Order for Change in Placement (In-Home to Out-of-Home 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 3 of 3 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. D. The department or agency shall conduct a diligent search in order to locate and provide notice as required by 24748.357(2v)(d) or 247938.357(2v)(d) , Wis. Stats., to all adult relatives of the child/juvenile , including the three adult relatives provided by the parents under 24748.357(1)(c)2m. or 247938.357(1)(c)2m . , Wis. Stats., no removal from the home, unless the search was previously conducted and notice provided. E. ays from the date of and shall be made part of this O rder. F . The parent(s) shall contribute toward the expenses of custody/servic es in the amount of $ . to be determined by [ Agency ] . G . 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. H . All provisions of the dispositional order not changed by this order remain in full force and effect. I. 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 resto ration of visitation rights. Written TPR Warnings are attached. Conditions for return/ visitation are part of this O rder or attached . J . Other: TH IS 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