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700-00093M – Guardian’s Annual Personal Status Report for Minor (08/2018) Page 1 of 3

STATE OF VERMONT

SUPERIOR COURT

PROBATE DIVISION

Unit

Docket No.

In re Guardianship of :

GUARDIAN’S ANNUAL PERSONAL STATUS REPORT FOR MINOR

The following is a report to the Court concerning:

Name of Minor

for the period beginning

and ending

I hereby state under oath that the following facts are true concerning the minor who is under my

guardianship.

1. Minor’s current address:

Mailing Address

*Physical Address (if different)

The minor resides (check one):

☐ At my home.

☐ Other (describe)

2. Minor’s current health, development and health care needs: (describe any strengths and

concerns and all aspects of health care for the minor, including his/her physical health,

mental health and dental care.)

3. Other Services Received and Involvement with Department for Children and Families or

the Courts (describe any services the minor has received other than those described in item 2

above and any involvement with the Department for Children and Families or the Courts)

Physical Address (if different)

Age of Minor

*Please provide name of residential provider and address if minor does not reside with the guardian

700-00093M – Guardian’s Annual Personal Status Report for Minor (08/2018) Page 2 of 3

4. Minor’s educational activities and progress: (include name of any school, day care or early

education program attended by minor; the minor’s grade level; and any educational

achievements.)

5. Relationship between minor and minor’s parents: (Describe contact between minor and

each of minor’s parents including frequency and duration of contact and whether contact was

supervised. Describe degree to which parents are involved in decisions about minor.)

6. My activities as guardian for the minor: (Describe the manner in which you have carried out your

responsibilities and duties including efforts to include either or both parents in the minor’s life.)

7. Minor’s Strengths, Challenges and/or Areas of Concern: (Describe the minor’s strengths and

challenges as well as any areas of concern to you)

700-00093M – Guardian’s Annual Personal Status Report for Minor (08/2018) Page 3 of 3

8. Minor’s Financial Assets:

I ☐ am ☐ am not

managing the minor’s financial assets other than Social Security benefits.

If you are, an annual summary of account must be filed with this report.

☐ I have attached a copy of the most recent report to Social Security regarding the

minor’s benefits.

9. Recommendations for changes to Guardianship Order:

I recommend that the Guardianship Order be changed: ☐ Yes ☐ No

If yes, attach a request to modify, amend or terminate Guardianship Order.

Date

Signature of Guardian

Guardian’s Mailing Address

____________________________________________

Guardian’s Phone Number: ___________________________________________

Guardian’s Email Address: ____________________________________________

_____________________________________________

Date

Signature of Co-Guardian

Co-Guardian’s Mailing Address

____________________________________________

Co-Guardian’s Phone Number: __________________________________________

Co-Guardian’s Email Address: ___________________________________________

Signed and sworn to before me:

Date Signature of Notary Public Expiration Date

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