Request for Prospective Adoptive Parent Designation

Request for Prospective Adoptive Parent Designation, Notice, and Order

After filling out this form, bring it to the clerk of the court. If you want to keep an address or telephone number confidential, fill out form JV-322, Confidential Information—Prospective Adoptive Parent, and do not write the address or phone number on this form.

1. Information about the person or persons you want to be designated as prospective adoptive parents:

a. Name:

b. Name:

c. Address:

d. Phone number:

2. If you are not a person in 1, fill out below.

a. My name:

b. I am the child child’s attorney other (specify role):

c. My address:

d. My phone number:

3. If you are not the child’s attorney and you know who the child’s attorney is, fill out below.

a. Name of child’s attorney:

b. Phone number of child’s attorney:

c. Address of child’s attorney:

4.

The child is 10 years of age or older. Child’s phone number: Telephone number is confidential

5.

The child lived with the person from (date): to (date):

and from (date): to the present.

In order for the person in 1 to become a prospective adoptive parent, the child must be living with that person now.

6.

Date of Welfare and Institutions Code section 366.26 hearing:

If a Welfare and Institutions Code section 366.26 hearing has not been set, it is too early to fill out this form. The person in 1 must wait until the section 366.26 hearing is scheduled and parental rights are terminated to be designated as a prospective adoptive parent.

7.

The person in 1 is committed to adopting the child.

8. The person in 1 has (check all that apply):

Applied for an adoptive home study

Cooperated with an adoptive home study

Signed an adoptive placement agreement

Requested de facto parent status

Been designated by the juvenile court or the licensed adoption agency as the adoptive family

Discussed a postadoption contact agreement with the social worker, child’s attorney, child’s CASA volunteer, adoption agency, or court

Worked to overcome any impediments that have been identified by the California Department of Social Services or the licensed adoption agency

Attended any of the classes required of prospective adoptive parents

Taken other steps toward adopting the child (explain):

Number of pages attached:

I declare under penalty of perjury under the laws of the State of California that the information in items 1 through 8 is true and correct, which means if I lie on this form, I am committing a crime.

NOTICE

10. Notice of the request for “prospective adoptive parent” designation was given to:

a. The adoption agency

(name of agency employee notified):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time):

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows:

b. The caregiver

(name):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time): Confidential phone number in court file

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows: Confidential address in court file

c. The child’s attorney

(name):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time):

(3) By personally delivering copies on (date): at (time):

d. The Child, if 10 years of age or older

(name):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time): Confidential phone number in court file

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows: Confidential address in court file

e. The child’s identified Indian tribe, if any

(name of tribe and person notified):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time): Confidential phone number in court file

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows:

f. The child’s Indian custodian, if any

(name):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time): Confidential phone number in court file

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows: Confidential address in court file

g. The child’s Court Appointed Special Advocate (CASA) program, if any

(name of person notified):

(1) Orally, in person on (date): at (time):

(2) Orally, by telephone on (date): at (time): Confidential phone number in court file

(3) By personally delivering copies on (date): at (time):

(4) By placing copies in a sealed envelope and depositing the envelope directly in the U.S. mail addressed as follows:

11.

At the time of notice I was at least 18 years of age and not a party to this matter. I work or am employed in the county where the mailing occurred. My residence or business address is (specify):

12.

I declare under penalty of perjury under the laws of the State of California that the information in items 10 and 11 is true and correct, which means if I lie on this form I am committing a crime.

ORDER

13. This order was made:

On the court’s own motion

At the request of (name):

(relationship to the child):

The request was made:

(1) Orally at the hearing held on (date):

(2) In writing by filing form JV-321, Request for Prospective Adoptive Parent Designation on (date):

The court finds and orders:

14.

The child’s current caregiver or caregivers

(name):

(name):

is are designated as the child’s prospective adoptive parent or parents because:

a. The child has lived with the caregiver for at least six months

b. The caregiver currently expresses a commitment to adopting the child and

c. The caregiver has taken at least one step to facilitate the adoption

15.

The child’s current caregiver or caregivers

does do not qualify as the prospective adoptive parent or parents of the child, and the request for designation as the prospective adoptive parent or parents is denied, because:

The child has not lived with the caregiver for at least six months

The caregiver does not currently express a commitment to adopting the child

The caregiver has not taken any steps to facilitate the adoption

Other (explain):

16.

The court thinks that the request for designation as a prospective adoptive parent will be contested or wants more evidence on the request, and orders a hearing on the request.

The hearing will be on (date): at (time): a.m. p.m.

in department of the superior court located at: