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State of Minnesota District Court
County Judicial District:
Court File Number:
Case Type: Juvenile
In the Matter of the Welfare of the Children of:
Guardian Ad Litem
Juvenile Court Report
Parent Legal Custodian
Parent Legal Custodian
Date of Report:
Date of Hearing:
Type of Hearing:
GUARDIAN AD LITEM APPOINTMENT
On , the Court issued an order requesting the guardian ad litem program to recommend a
guardian ad litem to advocate for the best interests of the child(ren) named below. On , the
undersigned individual was appointed as the guardian ad litem for the child(ren).
IDENTIFYING INFORMATION
Mother:
Father:
Father:
Legal Custodian:
Child(ren):
Child’s Name DOB Age
(at time of
report) Father’s Last Name
OUT-OF-HOME PLACEMENT INFORMATION
The child is in court-ordered out-of-home placement: YES NO
If YES, total number of days child has been in court-ordered out-of-home placement:
If YES, date by which permanent placement determination hearing must be commenced:
CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 1 of 4
INDIAN CHILD WELFARE ACT
The Indian Child Welfare Act applies to the child(ren) in this case: YES NO
If YES, list the name(s) of the child(ren) to whom the Act applies:
REASON FOR COURT INVOLVEMENT
Following is a brief summary of the issues that brought the child and family into the court
system:
COURT HISTORY
Following is a summary of the Court’s involvement in this case, any prior child protection cases,
and any related family court, criminal court, or other court cases, up to the date of this report:
Date Court Hearing or Other Event Court File No.
(If other than
juvenile court file)
CONTACT WITH CHILD(REN) SINCE LAST HEARING
Since the date of the last hearing, if any, I have had the following contact with the child(ren):
Date of
Contact Child Contacted Type of Contact
(In-person, Phone, Other)
CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 2 of 4
PERSONS AND OTHER RESOURCES CONTACTED SINCE LAST HEARING
Since the date of the last hearing, if any, the following persons and/or other resources have been
contacted by the guardian ad litem in an effort to learn information about the child(ren)’s and
families’ circumstances and progress:
Date of
Contact Person or Resource Contacted Title or Agency Name
DOCUMENTS REVIEWED SINCE LAST HEARING
Since the date of the last hearing, if any, the following documents have been reviewed and relied
upon by the guardian ad litem when preparing this report:
Date of Document Document Type/Title
RELATIVE SEARCH
The responsible social services agency has conducted a relative search regarding the child(ren) in
this case: YES NO
The following information is available about relatives available to serve as resources for the
child(ren) and family:
CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 3 of 4
SUMMARY OF INFORMATION AND CONCERNS
Based upon my contact with the children, contact with others, and review of documents since the
date of the last hearing, if any, following is a summary of the relevant information and concern’s
about the child(ren)’s or family’s situation:
RECOMMENDATIONS
Based upon my contact with the children, contact with others, and review of documents since the
date of the last hearing, if any, and based upon all the files and records related to this matter, the
best interests of the child(ren) will be served if the Court adopts the following
recommendation(s):
AMENDMENT OF REPORT
As permitted under Rule 38.05, subd. 1, of the Rules of Juvenile Protection Procedure, the
guardian ad litem reserves the right to amend and/or supplement this report as deemed necessary
or appropriate by the guardian ad litem. Such amendment or supplementation may be done
through a written addendum if time permits or, if time does not permit, orally at the time of the
hearing.
OBJECTION TO REPORT
Pursuant to Rule 38.05, subd. 4, of the Rules of Juvenile Protection Procedure, any party who
objects to the content or recommendations of this report may submit to the court and other
parties a written objection either before or at the hearing at which the report is to be considered.
Such objection shall include a statement certifying the content of the objection as true based
upon personal observation, first-hand knowledge, or information and belief. An objection may
be stated on the record as long as the Court gives the guardian ad litem a reasonable opportunity
to respond to the objection.
B Y SIGNING THIS REPORT I CERTIFY THAT THE CONTENT IS TRUE AND CORRECT BASED UPON
PERSONAL OBSERVATION , FIRST - HAND KNOWLEDGE , OR INFORMATION AND BELIEF .
Dated:
, Guardian Ad Litem
cc: , County Court Administration (original report)
, Assistant County Attorney
, Services Social Worker
, Attorney for Mother
, Attorney for Father
, Attorney for Child(ren)
, Attorney for Tribal Representative
, Other:
, Other:
CHP501 State ENG Rev 3/04-D www.courts.state.mn.us/forms Page 4 of 4
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