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Fill and Sign the Wisconsin Permanency Form

Fill and Sign the Wisconsin Permanency Form

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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF       Name Permanency Plan Hearing Order       Date of Birth Case No.       A request for hearing has been filed with the court and notice has been given to all interested parties. A hearing was held on (date)       , which is the effective date of this order. THE COURT HAS REVIEWED THE PERMANENCY PLAN FILED BY THE AGENCY AND FINDS: 1. a. The permanence goal for the child/juvenile has been: return to the home. adoption. placement with a guardian. permanent placement with a fit and willing relative. placement in one of the following alternative permanent placements: long term foster/residential care. independent living. sustaining care. b. This goal meets does not meet the needs of the child/juvenile. c. The permanency plan has or has not been complied with as follows: complied with not complied with agency service provider mother father child/juvenile child/juvenile’s guardian (if any) Comments:       d. The department or agency has has not identified the date by which the child/juvenile will likely be placed to conform with this permanence goal. Date       . 2. a. The concurrent permanence goal for the child/juvenile has been: return to the home. adoption. placement with a guardian. permanent placement with a fit and willing relative. placement in one of the following alternative permanent placements: long term foster/residential care. independent living. sustaining care. b. This goal meets does not meet the needs of the child/juvenile. JD-1791 , 04/07 Permanency Plan Hearing Order §48.38 and 938.38, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Permanency Plan Hearing Order Page 2 of 3 Case No. c. The permanency plan has or has not been complied with as follows: complied with not complied with agency service provider mother father child/juvenile child/juvenile’s guardian (if any) Comments:       d. The department or agency has has not identified the date by which the child/juvenile will likely be placed to conform with this concurrent permanence goal. Date       . 3. The continuing placement of the child/juvenile is is not necessary, safe and appropriate. 4. Adequate efforts have have not been made to involve the appropriate service providers in meeting the special needs of the child/juvenile and his or her parent(s). 5. Sufficient progress has has not been reached in eliminating the causes for the child’s/juvenile’s out of home placement. 6. Sufficient progress has has not been made toward returning the child/juvenile safely to his or her home or toward obtaining a permanent placement for the child/juvenile. 7. The child/juvenile has been placed out side of his or her home for 15 of the most recent 22 months. The permanency plan is: appropriate. not appropriate because it fails to sufficiently address the circumstances which prevent the child/juvenile from: being returned safely to the home; being placed safely in the home of a fit and willing relative; having a petition for involuntary termination of parental rights filed on behalf of the child; being placed for adoption; being placed with a guardian; being placed in some other alternative permanent placement, including sustaining care, independent living, or long term foster care/residential care. 8. Reasonable efforts to achieve the goal of the permanency plan were: made by the department or agency responsible for providing services:       not made by the department or agency responsible for providing services:       JD-1791 , 04/07 Permanency Plan Hearing Order §48.38 and 938.38, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Permanency Plan Hearing Order Page 3 of 3 Case No. THE COURT ORDERS: 1. The permanence goal for the child/juvenile remains is changed to: return to the home. adoption. placement with a guardian. permanent placement with a fit and willing relative. placement in one of the following alternative permanent placements: long term foster/residential care. independent living. sustaining care. 2. The concurrent permanence goal for the child/juvenile remains is changed to: return to the home. adoption. placement with a guardian. permanent placement with a fit and willing relative. placement in one of the following alternative permanent placements: long term foster/residential care. independent living. sustaining care. 3. Other:       4. The department or agency shall file a new permanency plan with the court. Date:       . Distribution: 1. Original - Court 2. Child/Juvenile and Attorney 3. Parents/Guardian 4. Legal and/or Physical Custodian/Attorney (if any) 5. Social Worker 6. Guardian ad Litem 7 District Attorney/Corporation Counsel 8. Placement Location 9. Court Appointed Special Advocate 10. Other       BY THE COURT: Circuit Court Judge/Commissioner       Name Printed or Typed       Date JD-1791 , 04/07 Permanency Plan Hearing Order §48.38 and 938.38, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3

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