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COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 1 1/1 /201 8 This juvenile cover sheet is required by Supreme Court Administrative Order 8. The data contained herein shall not be admissible as evidence in any court proceeding or replace or supplement the filing and service of pleadings, orders, or other papers as required by law or Supreme Court rule. Instructions are located on the following page. County: District: Filing Date: Judge: Division: Case ID: Case Type ( c hoose only one IF a new case or an adoption in a Dependency -Neglect case) :  □ (DX) Dependen cy □ (DN) Dependen cy-Neglect □ (JA) Juvenile Adoptio n □ (FS) FINS □ (FT) FINS Truancy Juvenile 1 Juvenile 2 Last Name Last Name Suffix Suffix First Name First Name Middle name Middle name DL/State ID / Contexte ID DL/State ID / Contexte ID SSN SSN Date of Birth Date of birth Sex □ Male □ Female  Sex □ Male □ Female  Ethnicity □ Hispanic □ Non -Hispanic  Ethnicity □ Hispanic □ Non -Hispanic  Race □ White □ Biracial □ Black □ Asian/Pacific Islander □ American Indian/Alaska Native □ Unknown Race □ White □ Biracial □ Black □ Asian/Pacific Islander □ American Indian/Alaska Native □ Unknown Removal date  Removal date  Education Plan □ IEP □ 504 □ N/A  Education Plan □ IEP □ 504 □ N/A  School status □ Under school age □ Enrolled □ Home-schooled □ Truant/not attending □ Suspended □ Expelled □ Withdrawn □ GED obtained □ Graduated High School School status □ Under school age □ Enrolled □ Home-schooled □ Truant/not attending □ Suspended □ Expelled □ Withdrawn □ GED obtained □ Graduated Hig h School  School name School name Interpreter needed? □ Yes: □ No (language) Interpreter needed? □ Yes: □ No (language) Case IDs of other cases involving this/these juvenile(s): COVER SHEET STATE OF ARKANSAS CIRCUIT COURT: JUVENILE DEPENDENCY-NEGLECT & FINS 2 1/1 /201 8 Petitioner □ Department of Human Services  □ Prosecuting Attorney /City Attorney □ Parent □ Other adult (complete petitioner information below) □ S chool representative (complete petitioner information below) . Attorney of Record : Bar #: For the: □ Petitioner □ Juvenile □ Parent □ Intervenor Email Address: Parent /Guardian 1 Last Name Phone Suffix Email First Name SSN Middle Name DOB DL/State ID / Contexte ID Interpreter needed? □ Yes: (language) □ No Address City, State ZIP Parent of □ All □ only this child(ren): Manner of filing: □ (MF O) Original □ Re -Open □ (MFT) Transfer If r eopen or petition in existing case , select the type of petition:  □ (MFRDX) Dependent □ (MFRDN) Dependent -Neglected □ (MFRFS) FINS (Truancy (MFRFT) □ Yes □ No) □ (MFRJC) Juvenile Civil Commitment  □ (MFRJA) Juvenile Adoption □ (MFRJE) Juvenile Custody □ (MFRJG) Juvenile Guardianship □ (MFRJT) Juvenile Paternity □ (MFRJS) Juvenile Support □ (MFRTP) Termination of Parental Rights  Petitioner (if school representative or other adult) Relationship to child(ren) Phone Last Name Email Suffix Self -represented □ Yes □ No First Name DOB DL/State IM Interpreter needed? □ Yes: □ No (language) Address City, State ZIP