New Guardianship Questionnaire Form (Page 2 of 8) in pdf

New Guardianship Questionnaire Form Page 2

NEW GUARDIANSHIP QUESTIONNAIRE FOR A MINOR

16.

Minor’s Race:

Height

Weight

17.

Minor’s Length of Time in Florida:

18.

Is minor a U.S. Citizen?

Resident alien?

19.

Attending Physician Name, Address, Phone Number:

20.

Describe the reason a guardianship is needed for the Minor (for example, the child inherited money;

the child was injured and will receive a settlement) and provide details:

21.

Names, phone number and addresses of Minor’s parents (identify if a parent is deceased and if

parents are divorced:

If divorced, who has custody?

22.

Name & address of bank to use as the court depository:

23.

Name of Petitioner (has personal knowledge of the incapacity and will sign the petition):

24.

Address/Phone # of Petitioner:

25.

Occupation/Title of Petitioner:

What health insurance does the minor have (list names, policy #):

26.

27.

Does the minor receive or, has he/she applied for the following public assistance:

Gross

YES

Monthly Amount

Date Applied

Medicaid

Supplemental Security Income

___

_____________

New Guardianship Questionnaire Form Page 2