Intake Form CONTACT INFORMATION: ***You should provide numbers where you are reachable between the hours of 8 am and 5 pm CST. It is preferable that a caseworker be able to leave messages at the contact numbers you provide.*** Do you have legal representation? In the pastPresentlyNever Have you had a psychological evaluation? YesNo Has anyone in your household ever been accused of child abuse? YesNo Do you have any prior history involving children protective services? YesNo Your Custody Status: Full CustodyJoint-CustodyUnsupervised VisitationSupervised VisitationNone ***The alleged perpetrator is the person named as the suspected abuser by your supporting documentation.*** The following information is used for statistical purposes only: Your household income: $0 – $8,999$9,000 – $17,999$18,000 – $33,999$34,000 – $62,999$63,000+ ALLEGED PERPETRATOR INFORMATION: Perpetrator’s Custody Status: Full CustodyJoint-CustodyUnsupervised VisitationSupervised VisitationNone Does the perpetrator have legal representation? In the pastPresentlyNever Has the perpetrator had a psychological evaluation? YesNo Has the perpetrator previously faced charges of criminal violence? YesNo Has the perpetrator previously been accused of child abuse? YesNo ***If you answered “yes” to any of the previous 3 questions, please provide us with supporting documentation if it is available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE COURT INFORMATION: Does the child, or children, have an ad litem? YesNo ***An ad litem (guardian ad litem or attorney ad litem) is a neutral party appointed by the court to represent the best interests of the child, or children.*** Is there a pending civil case? YesNo IF YES, please answer the following: Did you or someone else contact your local law enforcement agency? YesNo Did law enforcement file charges against the alleged perpetrator? YesNo Did the District Attorney’s Office accept the charges? YesNo Is there a pending criminal case? YesNo IF YES, please answer the following: CHILD PROTECTIVE SERVICES (CPS) INVOLVEMENT: Did you or someone else contact CPS? YesNo Did CPS validate the abuse allegations? YesNo ***By law, child abuse must first be reported to either law enforcement or protective services. Please attach the final results of those investigations if they are available to you.*** CHILD INFORMATION – CHILD 1 PLEASE COMPLETE ONE FOR EACH CHILD INVOLVED. FORMS FOR ADDITIONAL CHILDREN – LINKS AT BOTTOM OF PAGE Documentation supports what type(s) of abuse: SexualPhysicalNeglectEmotional More children in this home? YesNo Also victims of abuse? YesNo Has the child been examined by a doctor with expertise in child abuse? YesNo Was there medical evidence to support the abuse allegations? YesNo ***If yes, please enclose the results of this exam if they are available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE Has the child been examined by a any other doctor? YesNo Was there medical evidence to support the abuse allegations? YesNo ***If yes, please enclose the results of this exam if they are available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE Have the child had a psychological evaluation? YesNo ***If yes, please enclose the results of this exam if they are available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE Is the child attending ongoing therapy? YesNo Has the child made disclosures of abuse to his/her therapist? YesNo ***If yes, please enclose the results of this exam if they are available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE Has the child been interviewed by a social worker? YesNo Did the child disclose abuse to the social worker? YesNo ***If yes, please enclose a report if it is available to you.*** UPLOAD LINKS AT BOTTOM OF PAGE If you answered “no” to all of the above questions, and you do not have substantiated reports from law enforcement or protective services, please call JFC prior to submitting this packet to ensure that your documentation meets our criterion. DOCUMENTATION UPLOAD del del del del del del del del del Add file ADDITIONAL CHILDREN CLICK HERE TO ADD ADDITIONAL CHILDREN. NOTE: WHEN YOU CLICK THE LINK TO ADD MORE CHILDREN, A NEW WINDOW WILL POP UP. IF YOU HAVE POP-UPS TURNED OFF, PLEASE ALLOW THIS SITE TO SHOW POP-UPS WHEN ASKED. FILL OUT THE FORM(S) FOR THE REMAINING CHILD(REN) AND CLICK THE BUTTON TO SUBMIT. THEN PLEASE RETURN TO THIS PAGE AND THE BUTTON BELOW AS WELL. Need Help? Start the process of getting help, or getting help for a child in need, now. Intake Form Protective Order Form Formulario de orden de protección Ayudar a un niño que lo necesita ahora. Learn More Advocacy Justice for Children assists and refers several thousand callers annually through the complicated and unsympathetic maze of governmental agencies established to protect abused children. Advocating for an abused or neglected child takes on many different forms of participation and involvement. These include researching and gathering supporting documentation; reviewing supporting documentation; referring persons to professionals; guiding them through the legal and judicial process; initiating child abuse investigations; generating advocacy correspondence and amicus briefs; and acting as facilitator of professional services. Legislation Justice for Children has proposed and drafted legislation to improve the laws pertaining not only to child abuse and child protection, but also laws concerning the funding for protective services. We have also presented legislation designed to make the legal process more child-friendly. Additionally, because of its experience in this area, Justice for Children receives numerous requests to provide testimony regarding various pieces of legislation around the country. Legal Justice for Children is involved in a variety of legal research projects and has contributed to amicus briefs, researching legal issues and providing data on important legal issues affecting the rights of abused children. Education Justice for Children has traditionally provided information and materials to combat child abuse and to educate the public of the signs and symptoms of child abuse or neglect in its efforts to interrupt its dismal cycle. In 2012, it is initiating a project called “Just in Time”, to develop a series of informational and instructional modules to be placed on its website. Each is designed specifically to aid a field on the front lines of identifying and re-mediating child abuse: the community, medical first responders, school personnel, pediatricians, court personnel, and counseling professionals. Collaboration We seek to collaborate with other concerned national and community leaders, professionals, institutions, non-profit organizations, and governmental agencies to further a common goal of solving the deficiencies in our present child protective systems. By expanding our relationships within the community and on a national level, we are working to create a system that will effectively handle a child’s initial report of abuse, provide immediate safety, and ultimately, prosecute and convict the child abuser. National Justice for Children’s expert opinion continues to be recognized and valued by local and national media, legal and medical professionals, child abuse experts, and various other children’s rights organizations. We have been featured on ABC’s Primetime Live, ABC’s prime-time documentary entitled ‘Crimes Against Children,’ a PBS documentary entitled ‘Boy Crying, Baby Crying,” as well as appearances on Good Morning America, Donahue, the Discovery channel’s “Justice Files,’ HBO and in 2011, the BBC.