Sca-Fc-128 Worksheet For Individual Proposed Parenting Plan
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4IN THE FAMILY COURT OF ________________ COUNTY, WEST VIRGINIA.
In Re:
The Marriage / Children of:
Civil Action No. ____________
_________________________,
and
_________________________.
Petitioner
Respondent
_________________________
_________________________
_________________________
_________________________
Address
Address
_________________________
_________________________
Daytime phone
Daytime phone
Worksheet for Individual Proposed Parenting Plan
This Worksheet completed by: ____________________________
Date: _________
(Print your name.)
PARENTING RESPONSIBILITIES
Complete the following list which shows how you and the other parent have shared
parenting responsibilities in the last twelve months before your divorce was filed. Do not
provide information for any time after the filing of the divorce.
This list is for the children named: ________________________________________.
(A) Daily physical needs and care.
Examples: feeding; bedtime and wake-up routines; care when child is sick or hurt;
bathing, grooming, personal hygiene, dressing; recreation and play; physical safety;
transportation.
Mother ___%
Father ___%
(B)
Developmental needs.
Examples: learning to walk, talk, and use eating utensils; toilet training; development of
self-confidence and maturity.
Mother ___%
Father ___%
(C)
Development of proper behavior.
Examples: discipline; instruction in manners; assignment and supervision of chores.
Mother ___%
Father ___%
(D)
Educational matters.
Examples: making school arrangements; communicating with teachers and counselors;
supervision of homework; monitoring grades and discussing school related matters.
Mother ___%
Father ___%
SCA-FC-128 (12/01)
Worksheet for Individual Proposed Parenting Plan
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