Child Custody Questionnaire Template Page 5
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7ix.
Have any of these allegations been confirmed?
x.
Have there been any allegations of spousal abuse by any party to
this action?
xi.
Have any of these allegations been confirmed?
xii.
Does either party have a driving record(excessive violations,
OUIL's, or reckless and/or careless driving convictions)?
xiii.
What has the child's exposure to moral issues been and what has
the child's response been to the same?
(7)
The mental and physical health of the parties involved.
i.
State the physical health, any chronic illness or medicine taken
regularly of all parties to this action.
ii.
State the mental health history, marriage counseling or
hospitalizations of all parties to this action.
iii.
Have the parties to this action had counseling?
iv.
Is mental/emotional health related to divorce/custody disputes or
to long-term instability?
(8)
The home, school, and community record of the child?
i.
What school does the child attend?
ii.
What is the attendance record of the child?
iii.
What is the academic record of the child?
iv.
What is the child's attitude toward school?
v.
What extracurricular activities does the child participate in?
vi.
What is the parents' involvement in these activities, if any?
vii.
What the child's responsibilities at home (cleans room, does
dishes, mows grass)?
viii.
What the parties' involvement in the child's responsibilities?
ix.
Does the child have any juvenile or other agency involvement?
x.
Does the child have close relationships with friends in the area?
(9)
The reasonable preference of the child, if the court deems the child to
the child to be of sufficient age to express a preference.
i.
Do you feel the child has a preference?
ii.
How do you feel the child would react if a change of custody is
granted?
iii.
Why does the other party want this change of custody?
iv.
Why don't you want this change of custody?
502 Railroad Avenue, P.O. Box 5263, Traverse City, MI 49696
Tel: 231-929-7744
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Fax: 231-929-7766
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