IN THE CIRCUIT COURT OF THE TWELTH JUDICIAL CIRCUIT
IN AND FOR, ____________ COUNTY, FLORIDA
JUVENILE DIVISION
IN THE INTEREST OF:
LAST NAME, First Name
LAST NAME, First Name
CASE NO:
DOBs: XX/XX/XX
XX/XX/XX
Child(ren)
___________________________________________ /
GUARDIAN AD LITEM REPORT TO THE COURT
Guardian ad Litem:
Type of Hearing:
Date of Hearing:
Case Plan Goal:
Length of time child in out of home care:
Number of placements:
RECOMMENDATIONS
The recommendations should cover in order, the issues of placement, services for the child,
visitation, permanency and any other specific issue the Guardian feels necessary. All
recommendation should be in active voice which means - "Who is to do what and for whom"
1.
2.
3.
CHILD’S WISHES
This should be what the child has expressed that he or she wants, i.e. stay where they are,
reunification; and if the child wants to come to court and speak to the judge. If the child wants to
speak to the judge, this section should also include issues the child wants to raise. If the child is
not coming to court, why not? If the GAL believes that it is not in the child's best interest to
attend court please state that here.
TIMELINE TO PERMANENCY/CASE HISTORY
This section will be a narrative case history and must include the date of shelter/date of
GAL Program appointment, date of adjudication, current case plan acceptance date, case plan
expiration date, and the date the current GAL accepted the case.
GUARDIAN AD LITEM REPORT TO THE COURT
CASE NAME; CASE NO:
PAGE 2 OF 3
CHILD(REN) STATUS
This section should begin with a short narrative about the child’s current status. At a minimum,
this section must include date GAL last visited child and information on the following areas (if
applicable). The questions listed below are meant to act as prompts for the writer to consider in
each case and should be answered in a narrative format.
Placement History/Disruption:
 How long has child been in current placement?
 How is the child adjusting to his/her current placement?
 Has the child had multiple placements and if so is there a common reason for the
breakdown of these placements?
Mental/Medical Health (special needs/disabilities) (if applicable):
 Does the child have a mental health diagnosis and if so, what is it?
 Is the child participating in therapy or any other services related to this mental
health diagnosis?
 Is the child currently on any medications? (Include name, dosages and start dates).
 What effects has the medication had on the child? (note both behavioral effects
and side effects)
 What is the monitoring plan for the child’s medication? (include date of last
evaluation/next medication management date)
 Does the child have any medical needs and are they being met?
 Does the child currently receive any type of social security benefit?
Education/Daycare (if applicable):
 How is the child doing in school and or daycare/preschool; Is the child
performing at grade level; Are the child’s educational needs being met? Are there
any additional services needed?
Independent Living (if applicable):
 Does the child qualify for Independent Living Services and if so, what services is
the child receiving?
CASE PLAN PROGRESS
A. Case Plan Acceptance Date: xx/xx/xx
Case Plan Goal:
GUARDIAN AD LITEM REPORT TO THE COURT
CASE NAME; CASE NO:
PAGE 3 OF 3
B. Mother’s Progress on case plan tasks:
This section should include a short narrative on what specifically the mother has done or
not done on each of her case plan tasks. The GAL should not make the determination as
to compliance or non-compliance. Answer the question - What has the mother done. If
the goal is adoption, or the mother has been TPR’d, this section is not applicable and this
part can be deleted or marked "TPR'd.
C. Father’s Progress on case plan tasks
This section should include a short narrative on what specifically the father has done or
not done on each of his case plan tasks. The GAL should not make the determination as
to compliance or non-compliance. Answer the question - What has the father done. If the
children have different fathers, please address each father separately . If the goal is
adoption, or the father or father's have been TPR’d, this section is not applicable and this
part can be deleted or marked "TPR'd.
SOURCES CONTACTED/CONSULTED (Since the last Guardian ad Litem report dated
Month, day, year)
Since the last report the Guardian ad Litem has spoken to the following people: First
name, last name, Title; First name, Last name, Title; etc. Additionally, the Guardian ad Litem
has reviewed the following documents: document name, etc.
SUMMARY/ASSESSMENT
This section is optional and should contain information that is reflective of your
recommendations to the court, but should not repeat your recommendations.
Respectfully Submitted,
____________________________________
Guardian ad Litem Name
Guardian ad Litem
12th Judicial Circuit
Date: _______________________________
_________________________________
CAC - Name
Child Advocacy Coordinator
12th Judicial Circuit
Date: ___________________________