Fill and Sign the Wisconsin Interstate Compact Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       a person under the age of 18. Priority Placement Order (Interstate Compact on the Placement of Children)       Date of Birth Case No.       THE COURT FINDS: 1. The child is within the jurisdiction of this court. 2. (Name)       is the proposed placement resource in the receiving state of       and is a relative of the child as set forth in Article VIII(a) of the Interstate Compact on the Placement of Children (Compact). 3. The placement is not for licensed foster family approved care or adoption, and the child is not located in the receiving state in violation of the Compact. 4. The child qualifies for a priority placement under “Priority Regulation No. 7” of the Compact by meeting one or more of the following requirements: a. The child is under two years of age. b. The child has spent a substantial amount of time in the home of the proposed placement resource. c. The child is in an emergency shelter (specify) :       d. A properly completed standard (non-priority) compact request has been received by the receiving state. The Wisconsin Compact Office has not received a written response within 30 business days. 5. If a home study and case plan are approved by the receiving state, this placement would not be contrary to the best interest of the child. THE COURT ORDERS: 1.       County is authorized to be the sending agency for the child under the terms of the Compact adopted by §48.988, Wisconsin Statutes, and designates and directs the County Department of Health and Human Services or any receiving state agency to complete, carry out and effectuate all obligations and responsibilities of the sending agency under the Compact. 2.       County, or any receiving state agency, shall immediately commence procedures necessary for priority placement of the child with the placement resource indicated above. 3. Within two business days the court shall provide a copy of this order to the authorized sending agency. 4. Within three business days of receipt of this order, the sending agency shall transmit a copy of this order, a completed form ICPC 100-A, and supporting documentation to the Compact Administrator of the sending state with notice of the priority status of this request for placement. 5. The Compact Administrator of the sending state and all other persons to whom Article VII of the ICPC applies shall comply with Regulation 7 and shall fully implement the procedures for the request for priority placement. 6. The receiving state shall comply with Priority Regulation No. 7 and provide the completed home study to the State of Wisconsin Compact Administrator within 30 days of receipt. Circuit Court Address and Phone Number       BY THE COURT: Circuit Court Judge Distribution: 1. Original - Court 2. Sending agency       Name Printed or Typed       Date JC-1648 , 06/02 Priority Placement Order (Interstate Compact on the Placement of Children) §§48.988, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.