Fillable Trial Court of Massachusetts - Application for Child Requiring Assistance

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Trial Court of Massachusetts - Application for Child Requiring Assistance

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COUNTY[IES] DIVISION
TRIAL COURT OF MASSACHUSETTS
JUVENILE COURT DEPARTMENT
DOCKET NO.
SCHOOL DISTRICT
APPLICATION FOR CHILD REQUIRING ASSISTANCE
JV-088 (11/05/2012)
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__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
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Child's Name:
D.O.B.
School:
Current Grade
The applicant alleges that the above named child and the child's family require assistance as
defined in G.L. c. 119, § 21, in that said child who is between the ages of six and eighteen:
is habitually truant.
The child and the child's family
have
have not participated in a truancy prevention
program. A truancy prevention program
is is not available at this time. If a program
was available and the child and family did not participate, state the reason for their non-
participation.
If the child and and family participated in a program, state specific steps taken under the
program to prevent the child's truancy.
Separate sheet attached.
The following specific steps were taken to address the child's conduct: (attach sheet if
needed)
Date
Signature
Print Name and Title
Address
Telephone Number
repeatedly fails to obey lawful and reasonable regulations of the child's school.
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Trial Court of Massachusetts - Application for Child Requiring Assistance

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Completed 17 May 2020

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