Fillable STATEOFVERMONT SUPERIORCOURT FAMILYDIVISION Unit DocketNo. GuardianadLitemPretrialProceeding (Vermont Judiciary)

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STATEOFVERMONT SUPERIORCOURT FAMILYDIVISION Unit DocketNo. GuardianadLitemPretrialProceeding (Vermont Judiciary)

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Form897A Page1of3

6/14



GuardianadLitemPre‐trialProceeding

ActivitiesList

(domesticcases)



1. Iwasappointedastheguardianadlitemforthechild/childrenofthepartieson

__________________,20___.

2. ThefollowingisalistoftheactivitiesthatIhavecarriedoutinconnectionwiththiscase

sinceMyAppointmentMyLastReport.

Checkallthatapply

 Metwiththefollowingchild/renwhois/arethesubjectofthiscase:

NameofChild DateofMeeting



  Metwith/spoketotheparentsorguardianofthechild/children:

 Mother

 Father

 Otherparent

 LegalGuardian

 Observedchild/renwithparent

 Mother

 Father

 Otherparent

 LegalGuardian

STATEOFVERMONT



SUPERIORCOURT  FAMILYDIVISION

Unit   DocketNo.



PlaintiffName



v.

DefendantName



Form 897A Page2of3

6/14



 Servedasacontactbetweenparent(s)andchild/ren



 Metwith/spoketothefollowingrelativesorthosewithsignificantrelationship

withchild/ren

 Grandmother(paternal)

 Grandfather(paternal)

 Grandmother(maternal)

 Aunt/Uncle

 OtherSignificantRelationship______________________________

 Otherrelative_________________________________________



 Metwithorspoketoschool/daycarepersonnel:(releasesobtained)

 Classroomteacher

 SpecialEducationTeacher

 SpecialEducationTeam/IEP

 Counselor/MentalHealthProfessional

 SchoolNurse

 Administrator

 DaycareProvider



 MetwithorspoketoChild’sHealth/Medical/MentalHealthProfessionals

(releasesobtained) 

 Pediatrician

 MentalHealthProfessional

 Other_____________________________________________



 MetwithorspoketoParent’s/LegalGuardian’sHealth/Medical/MentalHealth

 Professionals(releasesobtained)

 Doctor

 MentalHealthProfessional

 Other_____________________________________________



Form 897A Page3of3

6/14

 ReviewedRecords

 CourtRecords(includingreportssuchasforensicevaluationorhomestudy)

 MedicalRecords

 EducationalRecords

 Other______________________________________________



 RequestedAppointmentofAttorneyforChild/renpursuanttoVRFP7(e)(6)



 Performedthefollowingotherdutiesonbehalfofthechild/renasdirectedbythe

Court. Describeotherdutiesbelow.



Respectfullysubmitted:



Dated



Signature





PrintedName



cc:Plaintifforattorneyforplaintiff

Defendantorattorneyfordefendant



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STATEOFVERMONT SUPERIORCOURT FAMILYDIVISION Unit DocketNo. GuardianadLitemPretrialProceeding (Vermont Judiciary)

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Completed 30 July 2020

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