Criminal Intake Form – Fill Out and Use This PDF

The Criminal Intake Form serves as a comprehensive document designed to collect vital information about a minor involved in a court case—ranging from personal details, like name and date of birth, to more complex data related to their case, placements, and family dynamics. By meticulously capturing this array of data, it ensures that legal professionals and volunteers, such as those from CASA (Court Appointed Special Advocates), are well-equipped to provide the tailored support and advocacy needed for each child’s unique situation. For those involved in the care or legal representation of a minor, completing this form accurately and promptly is a crucial step towards securing the child's welfare and rights.

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Criminal Intake Form PDF Details

The Criminal Intake Form stands as a cornerstone for managing and organizing essential information required for an effective support system for children involved in criminal proceedings. Specifically designed for CASA volunteers (Court Appointed Special Advocates), this comprehensive form records critical data ranging from basic personal information, including the child's name, case number, date of birth, gender, and language, to more detailed aspects such as social security number, racial background, and information on removal from the home. Additionally, it extensively covers the type and location of placement, legal guardianship details, court dates, and CASA volunteer assignment. Another pivotal aspect of the form includes a section dedicated to family and contact information, ensuring a holistic approach to understanding the child's social and familial environment. It also servesto assess and list any disabilities, concerns for the child or family, and involves a tracking mechanism for CASA volunteers to log interactions and activities related to each case. The criminal intake form not only ensures methodical case management but also aids in tailoring the support and intervention strategies to the specific needs of the child, ultimately aiming for a resolution that serves the best interest of the child.

Question	Answer
Form Name	Criminal Intake Form
Form Length	8 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min
Other names	criminal law intake form, DJJ, criminal client intake form, Homestudy

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CASA INTAKE FORM

CHILD’S NAME:							CASE #:

DOB:	/	/		GENDER :	Male	Female	SOCIAL SECURITY #:		-	-

PRIMARY LANGUAGE:			English	Spanish	Asian Language		CHILD IS REMOVED FROM HOME: YES NO
PRIMARY LANGUAGE:			English	Spanish	Asian Language
			Arabic	Sign Language		Other	DATE REMOVED:	/		/
			Arabic	Sign Language		Other

RACE:
American Indian/Alaska Native	Asian/Asian-American
Black/African-American	Hispanic/Latino
Native Hawaiian/Other Pacific Islander
White	Other

CAREGIVER’s PHONE: (H) (		)	-

	(W) (	)	-
ADDRESS:
CITY/COUNTY:
STATE/ZIP:

TOTAL NUMBER OF PLACEMENTS PRIOR TO CASA:

#______

TOTAL NUMBER OF MONTHS IN PRIOR PLACEMENT(S):

#_____

PLACEMENT

Acute psychiatric facility Custody to other parent Custody with relative Detention

DJJ

Emergency shelter Foster home Group home Medical facility Own home father Own home mother Own home parents Relative foster care Relative placement Residential Therapeutic foster care Third party custody Runaway

(whereabouts unknown)

Short term diagnostic

Trial placement in home

COURT INFORMATION

OPEN DATE:

ASSIGNMENT DATE:

NAME OF CASA VOLUNTEER :

PETITION TYPE AT ASSIGNMENT:

ABUSE/NEGLECT

CHINS

CUSTODY/VISITATION

ENTRUSTMENT

RELIEF OF CUSTODY

OTHER

JUDGE:

COURT DATE:

GAL:

PHONE: (

)

COURT ORDERED VISITATION?

YES NO

LEGAL GUARDIAN/DSS SOCIAL WORKER

SUPERVISED VISITATION?

YES

NAME:

COURT APPROVED THE FOLLOWING NAMES FOR

PHONE:

(H) (

)

VISITATION:

ADDRESS:

(W) (

)

VISITATION SCHEDULE:

CITY/COUNTY:

DATE OF NEXT VISITATION:

STATE/ZIP:

MOTHER

FATHER

NAME:

PHONE:

(H) (

)

PHONE:

(H) (

)

(W) (

)

(W) (

)

ADDRESS:

CITY/COUNTY:

STATE/ZIP:

SIBLING

OTHER

NAME:

PHONE:

(H) (

)

PHONE:

(H) (

)

(W) (

)

ADDRESS:

(W) (

)

ADDRESS:

CITY/COUNTY:

STATE/ZIP:

Criminal Intake Form – Fill Out and Use This PDF

Criminal Intake Form PDF Details

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