CASA Report Form to the Court v2

2. Case Identifier/Number*

   Insert Case JC#

3. Case Status*

   1. Alleged
   2. Adjudicated
   3. N/A

5. CASA/GAL Name*

   Use your CASA/GAL name

6. Choose one*

   1. CASA/GAL
   2. Attorney: Pro Bono

8. Child Name*

   First Name, Last Name

9. Date of Birth*
   Date of Birth

11. Child Name 2

12. Child 2 Date of Birth
    Child 2 Date of Birth

14. Child Name 3

15. Child 3 Date of Birth
    Child 3 Date of Birth

17. Child Name 4

18. Child 4 Date of Birth
    Child 4 Date of Birth

20. Child Name 5

21. Child 5 Date of Birth
    Child 5 Date of Birth

23. Child Name 6

24. Child 6 Date of Birth
    Child 6 Date of Birth

26. Basis for Court Involvement:

28. Check all that apply*

    1. Dependancy
    2. Neglect
    3. Physical Abuse
    4. Sexual Abuse
    5. Emotional Abuse
    6. Crossover
    7. Custody/Visitation
    8. Other

29. Other Description

31. Type of Hearing
    -- Select One --Adjudication/DispositionAnnual ReviewCustodyDelinquencyDispositionMediationParental RightsPermanent CustodyPPLAVisitionOther

32. Other Description

34. Date of Complaint/Petition:
    Date of Complaint/Petition:

35. Date of GAL Appointment
    Date of GAL Appointment

37. Assigned to Judge
    -- Select One --CASA Office should insert JudgeDenise Navarre CubbonConnie ZemmelmanVisiting Judge:

38. Visiting Judge Name

40. Assigned to Magistrate
    -- Select One --AdyaCairlHutchesonJonesFieldRestivoRutledgeSorahOther:

41. Other Magistrate name

Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field