Skip to Main Content
Loading
Loading
Government
Departments
Visitors
How Do I...
Home
Form Center
Form Center
Search Forms:
Search Forms
Select a Category
All Categories
Auditor
Board of County Commissioners
Board of Elections
Building Regulations
Canine Care and Control
CASA
Child Support Enforcement Agency
Clerk of Courts
Common Pleas Court
Coroners Office
Court Services
Diversity, Equity, & Inclusion
Domestic Relations Court
Emergency Management Agency
Emergency Medical Services / 911
Engineer
Facilities
Family Council
Human Resources
Integrated Justice Systems
Job and Family Services
jpztest
Juvenile Court
Juvenile Treatment Court
KT/LCB
Law Library
LCCS
LCIS
Local Emergency Planning Committee
Lucas County Guardianship Services Board
Lucas County Guardianship Services Board
Lucas County Sheriff
Office of Management and Budget
Ohio 6th District Court of Appeals
Planning and Development
PREA
Prosecutor
PTSI
Purchasing
Recorder
Recreation
Risk Management
Sanitary Engineer
Soil and Water Conservation
Solid Waste
Treasurer
Veterans Services
Victim Witness
Water Resource Recovery Facility
Wellness Benefits
By
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
CASA Report Form to the Court
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Case Identifier/Number
*
Insert Case JC#
Case Status
*
Alleged
Adjudicated
N/A
CASA/GAL Name
*
Use your CASA/GAL name
Choose one
*
CASA/GAL
Attorney: Pro Bono
Add a 2nd CASA/GAL
Yes
No
CASA/GAL #2
Choose one
CASA/GAL
Attorney: Pro Bono
Child Name
*
First Name, Last Name
Date of Birth
*
Date of Birth
Add a 2nd child
Yes
No
Child Name 2
Child 2 Date of Birth
Child 2 Date of Birth
Add a 3rd child
Yes
No
Child Name 3
Child 3 Date of Birth
Child 3 Date of Birth
Add a 4th Child
Yes
No
Child Name 4
Child 4 Date of Birth
Child 4 Date of Birth
Add a 5th Child
Yes
No
Child Nname 5
Child 5 Date of Birth
Child 5 Date of Birth
Add a 6th Child
Yes
No
Child Name 6
Child 6 Date of Birth
Child 6 Date of Birth
Basis for Court Involvement:
Check all that apply
*
Dependancy
Neglect
Physical Abuse
Sexual Abuse
Emotional Abuse
Crossover
Custody/Visitation
Other
Other Description
Type of Hearing
-- Select One --
Adjudication/Disposition
Annual Review
Custody
Delinquency
Disposition
Mediation
Parental Rights
Permanent Custody
PPLA
Visition
Other
Other Description
Date of Complaint/Petition
Date of Complaint/Petition
Date of GAL Appointment
Date of GAL Appointment
Assigned to Judge
-- Select One --
CASA Office should insert Judge
Denise Navarre Cubbon
Connie Zemmelman
Visiting Judge:
Visiting Judge Name
Assigned to Magistrate
-- Select One --
Adya
Cairl
Hutcheson
Jones
Field
Restivo
Rutledge
Sorah
Other:
Other Magistrate name
Prior CASA/GAL Report(s) Filed
No
Yes, See Court File
CASA/GAL has Attended all Hearings since Appointment
Yes
No
Photo
Date of Missed Hearing
Date of Missed Hearing
Reason for Missed Hearing
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing
Add Missed Hearing Date #2
Yes
No
Date of Missed Hearing #2
Date of Missed Hearing #2
Reason for Missed Hearing #2
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing #2
Add Missed Hearing Date #3
Yes
No
Date of Missed Hearing #3
Date of Missed Hearing #3
Reason for Missed Hearing #3
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing #3
Add Missed Hearing Date #4
Yes
No
Date of Missed Hearing #4
Date of Missed Hearing #4
Reason for Missed Hearing #4
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing #4
Add Missed Hearing Date #5
Yes
No
Date of Missed Hearing #5
Date of Missed Hearing #5
Reason for Missed Hearing #5
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing #5
Add Missed Hearing Date #6
Yes
No
Date of Missed Hearing #6
Date of Missed Hearing #6
Reason for Missed Hearing #6
-- Select One --
Another GAL Covered
Emergency
Ill
No Notice of Hearing
Other
Other Reason for Missed Hearing #6
Case History
Include the information in the numbered paragraphs of the LCCCS Complaint beginning with paragraph 4 and then add "At the Emergency Shelter Care Hearing held on (insert date) the Court awarded _______ custody and the children were placed ________."
Documents Reviewed
Agency
-- Select One --
A OK Program
Centralized Drug Testing
Child Advocacy Center (CAC)
CRC (Visits)
Cullen Center
East Toledo Family Center
Harbor
Help Me Grow
Lucas County Sheriff
LCCS
Lucas County Juvenile Court
Rescue Crisis
SASI
St. Charles Hospital
St. Vincent Hospital
Toledo Hospital
Unison
Other
Type of Document
-- Select One --
Drug Test
File
Medical Records
Police Check
Report
Other
Re: Who?
-- Select One --
Child
Children
Family
Father
Father's Girlfriend
Maternal Aunt
Maternal Grandfather
Maternal Grandmother
Maternal Great Grandfather
Maternal Great Grandmother
Maternal Uncle
Mother
Mother's Boyfriend
Parents
Paternal Aunt
Paternal Grandfather
Paternal Grandmother
Paternal Great Grandfather
Paternal Great Grandmother
Paternal Uncle
Step Father
Step Mother
Other
Add Document #2
Yes
No
Agency Other
Document Other
Who Other
Agency #2
-- Select One --
A OK Program
Centralized Drug Testing
Child Advocacy Center (CAC)
CRC (Visits)
Cullen Center
East Toledo Family Center
Harbor
Help Me Grow
Lucas County Sherriff
LCCS
Lucas County Juvenile Court
Rescue Crisis
SASI
St. Charles Hospital
St. Vincent Hospital
Toledo Hospital
Toledo Police
Unison
Other
Type of Document #2
-- Select One --
Drug Test
File
Medical Records
Police Check
Report
Other
Re: Who? #2
-- Select One --
Child
Children
Family
Father's Girlfriend
Maternal Aunt
Maternal Grandfather
Maternal Grandmother
Maternal Great Grandfather
Maternal Great Grandmother
Maternal Uncle
Mother
Mother's Boyfriend
Parents
Paternal Aunt
Paternal Grandfather
Paternal Grandmother
Paternal Great Grandfather
Paternal Great Grandmother
Paternal Uncle
Step Father
Step Mother
Other
Add Document #3
Yes
No
Agency Other #2
Document Other #2
Who Other #2
Agency #3
-- Select One --
A OK Program
Centralized Drug Testing
Child Advocacy Center (CAC)
CRC (Visits)
Cullen Center
East Toledo Family Center
Harbor
Help Me Grow
Lucas County Sheriff
LCCS
Lucas County Juvenile Court
Rescue Crisis
SASI
St. Charles Hospital
St. Vincent Hospital
Toledo Hospital
Unison
Other
Type of Document #3
-- Select One --
Drug Test
File
Medical Records
Police Check
Report
Other
Re: Who? #3
-- Select One --
Child
Children
Family
Father
Father's Girlfriend
Maternal Aunt
Maternal Grandfather
Maternal Grandmother
Maternal Great Grandfather
Maternal Great Grandmother
Maternal Uncle
Mother
Mother's Boyfriend
Parents
Paternal Aunt
Paternal Grandfather
Paternal Grandmother
Paternal Great Grandfather
Paternal Great Grandmother
Paternal Uncle
Step Father
Step Mother
Other
Add Document #4
Yes
No
Agency Other #3
Document Other #3
Who Other #3
Agency #4
-- Select One --
A OK Program
Centralized Drug Testing
Child Advocacy Center (CAC)
CRC (Visits)
Cullen Center
East Toledo Family Center
Harbor
Help Me Grow
Lucas County Sheriff
LCCS
Lucas County Juvenile Court
Rescue Crisis
SASI
St. Charles Hospital
St. Vincent Hospital
Toledo Hospital
Unison
Other
Type of Document #4
-- Select One --
Drug Test
File
Medical Records
Police Check
Report
Other
Re: Who? #4
-- Select One --
Child
Children
Family
Father
Father's Girlfriend
Maternal Aunt
Maternal Grandfather
Maternal Grandmother
Maternal Great Grandfather
Maternal Great Grandmother
Maternal Uncle
Mother
Mother's Boyfriend
Parents
Paternal Aunt
Paternal Grandfather
Paternal Grandmother
Paternal Great Grandfather
Paternal Great Grandmother
Paternal Uncle
Step Father
Step Mother
Other
Add Document #5
Yes
No
Agency Other #4
Document Other #4
Who Other #4
Leave This Blank:
Receive an email copy of this form.
Email address
This field is not part of the form submission.
Submit
* indicates a required field
Photo Gallery
About Us
Online Services
Arrow Left
Arrow Right
[]
Slideshow Left Arrow
Slideshow Right Arrow