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CASA Report Form to the Court

  1. Insert Case JC# (from the Complaint).

  2. Case Status*

  3. Use your CASA/GAL name.

  4. Choose one*

  5. Add a 2nd CASA/GAL

  6. Choose one CASA/GAL 2

  7. Enter first and last name of the child.

  8. Add a 2nd child

  9. Add a 3rd child

  10. Add a 4th Child

  11. Add a 5th Child

  12. Add a 6th Child

  13. Add a 7th Child

  14. Add an 8th Child

  15. Basis for Court Involvement:

    This is found in the caption of the Complaint.

  16. Check all that apply*

  17. File-stamped date on your JE of Appointment

  18. Prior CASA/GAL Report(s) Filed

    If you have written a prior report for this case (same case number) check "yes." Most often you will check "no."

  19. CASA/GAL has Attended all Hearings since Appointment*

    The initial emergency shelter care hearing does not count as the CASA was not yet appointed. If a CASA staff attorney covered for you, you must answer no.

  20. Add Missed Hearing Date 2

  21. Add Missed Hearing Date 3

  22. Add Missed Hearing Date 4

  23. Add Missed Hearing Date 5

  24. Add Missed Hearing Date 6

  25. File-stamped date on Complaint.

  26. At Emergency Shelter Care Hearing the Court awarded*

  27. Of which children?*

  28. Write full name and relationship to the child.

  29. Write full name and relationship to the child.

  30. Add Second Child

  31. Write full name and relationship to the child.

  32. Add Third Child

  33. Write full name and relationship to the child.

  34. Add Fourth Child

  35. Write full name and relationship to the child.

  36. Add Fifth Child

  37. Write full name and relationship to the child.

  38. Add Sixth Child

  39. Write full name and relationship to the child.

  40. Add Seventh Child

  41. Write full name and relationship to the child.

  42. Add Eighth Child

  43. Write full name and relationship to the child.

  44. Documents Reviewed

  45. Add Document 2

  46. Add Document 3

  47. Add Document 4

  48. Add Document 5

  49. Add Document 6

  50. Add Document 7

  51. Add Document 8

  52. Add Document 9

  53. Add Document 10

  54. Placement History:

  55. Type "All Children" if all of the children were moved to the same home at the same time.

  56. Add Placement 2

  57. Type "All Children" if all of the children were moved to the same home at the same time.

  58. Add Placement 3

  59. Type "All Children" if all of the children were moved to the same home at the same time.

  60. Add Placement 4

  61. Type "All Children" if all of the children were moved to the same home at the same time.

  62. Add Placement 5

  63. Type "All Children" if all of the children were moved to the same home at the same time.

  64. Persons Interviewed:

    List all the people you have interviewed and their relationship to the child(ren) involved on the case. Be sure to include CASA children interviewed or observed.

  65. Add Person Interviewed 2

  66. Add Person Interviewed 3

  67. Add Person Interviewed 4

  68. Add Person Interviewed 5

  69. Add Person Interviewed 6

  70. Add Person Interviewed 7

  71. Add Person Interviewed 8

  72. Add Person Interviewed 9

  73. Add Person Interviewed 10

  74. Add Person Interviewed 11

  75. Add Person Interviewed 12

  76. Add Person Interviewed 13

  77. Add Person Interviewed 14

  78. Add Person Interviewed 15

  79. Add Person Interviewed 16

  80. Add Person Interviewed 17

  81. Add Person Interviewed 18

  82. Add Person Interviewed 19

  83. Add Person Interviewed 20

  84. Attempted Contacts - Unsuccessful:

    List any parties you have tried unsuccessfully to interview and put in your attempts to reach these parties.

  85. Add Attempted Contacts - Unsuccessful 2

  86. Add Attempted Contacts - Unsuccessful 3

  87. Add Attempted Contacts - Unsuccessful 4

  88. Add Attempted Contacts - Unsuccessful 5

  89. Add Attempted Contacts - Unsuccessful 6

  90. Add Attempted Contacts - Unsuccessful 7

  91. Add Attempted Contacts - Unsuccessful 8

  92. Add Attempted Contacts - Unsuccessful 9

  93. Add Attempted Contacts - Unsuccessful 10

  94. Add Attempted Contacts - Unsuccessful 11

  95. Add Attempted Contacts - Unsuccessful 12

  96. Add Attempted Contacts - Unsuccessful 13

  97. Add Attempted Contacts - Unsuccessful 14

  98. Add Attempted Contacts - Unsuccessful 15

  99. Dates of Contact with Child:

  100. Type "All Children" if you saw all of the children at the same time.

  101. Add Date of Contact 2

  102. Add Date of Contact 3

  103. Add Date of Contact 4

  104. Add Date of Contact 5

  105. Add Date of Contact 6

  106. Add Date of Contact 7

  107. Add Date of Contact 8

  108. Add Date of Contact 9

  109. Add Date of Contact 10

  110. Add Date of Contact 11

  111. Add Date of Contact 12

  112. Add Date of Contact 13

  113. Add Date of Contact 14

  114. Add Date of Contact 15

  115. Add Date of Contact 16

  116. Add Date of Contact 17

  117. Add Date of Contact 18

  118. Add Date of Contact 19

  119. Add Date of Contact 20

  120. Child(ren)'s Well Being:

    Write in complete sentences in the comment section.

  121. Physical Health*

  122. Are Children on Target Developmentally?*

  123. Mental Health*

  124. Process*

    Do the children understand the situation?

  125. Safety*

    Do the children feel safe in their current environment?

  126. Financial Needs or Special Financial Circumstances*

  127. Are Children Visiting Parents, Siblings and Appropriate Relatives?*

  128. Has LCCS Arranged Case Plan Services?*

  129. Are Parties in Compliance with Court Orders?*

  130. This is a fact-based narrative section. Describe where each child is living and how each child is doing (positive and negative) in that placement. Describe the basic elements of the case plan (services). Describe parental and children's progress (or lack thereof) on case plan services. Is the Agency (LCCS) compliant with the goals of the case plan? Do not include a Case History or Recommendations and please do not repeat information.

  131. School Status:

    Include each child whether they are in school or not.

  132. School Type*

  133. Is the child age appropriate for the grade?

  134. Did the school change after removal?

  135. If in high school, is the teen on target toward graduation?

  136. Since removal, grades have:

  137. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  138. Add Child School Status 2

  139. School Type 2

  140. Is the child age appropriate for the grade? 2

  141. Did the school change after removal? 2

  142. If in high school, is the teen on target toward graduation? 2

  143. Since removal, grades have: 2

  144. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  145. Add Child School Status 3

  146. School Type 3

  147. Is the child age appropriate for the grade? 3

  148. Did the school change after removal? 3

  149. If in high school, is the teen on target toward graduation? 3

  150. Since removal, grades have: 3

  151. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  152. Add Child School Status 4

  153. School Type 4

  154. Is the child age appropriate for the grade? 4

  155. Did the school change after removal? 4

  156. If in high school, is the teen on target toward graduation? 4

  157. Since removal, grades have: 4

  158. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  159. Add Child School Status 5

  160. School Type 5

  161. Is the child age appropriate for the grade? 5

  162. Did the school change after removal? 5

  163. If in high school, is the teen on target toward graduation? 5

  164. Since removal, grades have: 5

  165. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  166. Add Child School Status 6

  167. School Type 6

  168. Is the child age appropriate for the grade?

  169. Did the school change after removal? 6

  170. If in high school, is the teen on target toward graduation? 6

  171. Since removal, grades have: 6

  172. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  173. Add Child School Status 7

  174. School Type 7

  175. Is the child age appropriate for the grade? 7

  176. Did the school change after removal? 7

  177. If in high school, is the teen on target toward graduation? 7

  178. Since removal, grades have: 7

  179. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  180. Add Child School Status 8

  181. School Type 8

  182. Is the child age appropriate for the grade? 8

  183. Did the school change after removal? 8

  184. If in high school, is the teen on target toward graduation? 8

  185. Since removal, grades have: 8

  186. This box is for comments regarding grade level, absences, grades, behavior, socialization, suspensions/expulsions, IEP or testing needed, etc.

  187. You must ask each child on your case, individually and in private, what the child wants regarding placement and permanence. The child's wishes may be different than your recommendations, but his or her wishes, as stated to you, must be reported in this section. You may quote the child. Example: "Johnny stated to me, 'I want to live with Mommy if her boyfriend moves out.'"

  188. State or list any strengths evident in the biological family from which the child was removed.

  189. Briefly list any specific concerns. This is not a place to put your recommendations, only your concerns not mentioned before in this report.

  190. Number each recommendation. Write each recommendation on its own separate line. Custody must be addressed as the first recommendation.

  191. In addition, the CASA/GAL requests the Court restrict access and place this report under seal to preserve the privacy, confidentiality, and safety of the parties and the best interests of the child(ren).

  192. REMINDER: Email individual photos of each child to the CASA office identifying what each child is wearing so we know which child belongs to which picture.

  193. By checking this box, I attest that I am the aforementioned CASA/GAL and this report is my work product.*

  194. Leave This Blank:

  195. This field is not part of the form submission.