Custody Evaluation Questionnaire Template Page 15
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2715
F.
YOUR BACKGROUND AND FAMILY OF ORIGIN
Where Born and Raised:
__________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
If you were born in another country, when and why did you
immigrate to the U.S. and when did you receive your permanent
residency and/or citizenship?
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Your Mother: (Describe her occupation and your relationship with
her when you were growing up and your relationship with her
now. Where does she now live and is she involved with your
children?)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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