California Confidential Guardianship Status Report

CONFIDENTIAL GUARDIANSHIP STATUS REPORT

CONFIDENTIAL GUARDIANSHIP STATUS REPORT

NOTICE TO GUARDIAN You must complete, sign, and return to the court on or before (date):

a separate copy of this form for each child for whom you are guardian of the person or estate under the above case number. If you are the guardian of the child's estate only, you must complete at least items 1-2, 6d, and 7-8. All other guardians must complete the entire form. Failure to complete, sign, and return this form will result in further court action, possibly including your removal as guardian.

An "Attachment" is one or more separate sheets of paper attached to this form. You may use any letter-sized paper for this purpose, including copies of Judicial Council form MC-025, Attachment, available from the court. Label each attachment with the item or question number you are answering.

1. Guardian* (Continue on Attachment 1 if necessary. If there is more than one guardian, each must provide the information requested in items 1a-f, and each must sign this form.):

a. (Name):

b. Present address (street address, including apartment number, city, state, and zip code, of each guardian):

c. Years at this address: Telephone (home): Telephone (work):

d. Do you have any significant health problems that would interfere with your ability to continue as guardian in the next year? No Yes

e. Since your appointment or your last report, have you, or has any adult living in the home where the child is living, been arrested for, charged with, or convicted of any offense involving alcohol, illegal drugs, or sexual misconduct? No Yes

f. Are you a court-appointed guardian or conservator for any other child or adult under a different case number or court? No Yes

* If you are the guardian of a child's estate, you must file regular accountings with the court in addition to this report.

2. Personal Information on Child Under Guardianship (continue on Attachment 2 if necessary):

a. (Name):

b. (Birthdate):

c. The child is is is not now living in my home.

d. (If the child lived in your home but has left, state when and why the child left. If the child has never lived in your home, please explain.):

e. (If the child is not now living in your home, state the complete name, relationship to child, address, and telephone number of the person the child is living with.):

3. Child's Education (continue on Attachment 3 if necessary):

a. Name and address of child's school:

b. Child's grade:

c. Describe the child's current progress in school, including grades, attendance, behavior problems, tutoring programs, etc.:

4. Child's Physical and Emotional Health (continue on Attachment 4 if necessary):

a. Is the child having any current medical or dental problems? No Yes

b. The child is is current on immunizations. is not current on immunizations.

c. Name, address, and telephone number of each physician, dentist, or other health care provider now seeing or treating the child:

d. Is the child having any emotional or behavioral problems that cause you concern? No Yes

e. Has the child experienced any traumatic event, major disruption or significant change during the past year?

f. Name, address, and telephone number of any therapist the child has been seeing:

g. Describe the child's social activities/services, including recreational, educational, church, social, occupational, or cultural activities:

h. Describe your goals for the child for the next year:

5. Other Persons in the Child's Home (complete on Attachment 5 if necessary):

a. Name, age, and relationship to the child and to you of each person now living in the child's home:

b. Name of each person identified in item 5a who moved into the child's home after the guardianship was established:

6. Child's Natural Parents (complete on Attachment 6 if necessary):

a. (1) Name, address, and telephone number of child's mother:

(2) Name, address, and telephone number of child's father:

b. Visits of child's mother: Yes No Frequency: Average length:

(1) Visits are supervised? Yes No

(2) Name and telephone number of person who is present during visits:

(3) Overnight visits: Yes No Address of overnight visits:

(4) Are there any problems during the visits? No Yes

c. Visits of child's father: Yes No Frequency: Average length:

(1) Visits are supervised? Yes No

(2) Name and telephone number of person who is present during visits:

(3) Overnight visits: Yes No Address of overnight visits:

(4) Are there any problems during the visits? No Yes

d. Financial contribution of either or both natural parents: Yes No. Average monthly amount:

7. Need for Guardianship

The guardianship is is is not still necessary (State reasons.)

8. Continuation as Guardian

I am am not able to continue my duties and obligations as the child's guardian.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.