Fillable Private Child Custody Evaluators Referral List (Page 2 of 2) in pdf

PRIVATE CHILD CUSTODY EVALUATORS REFERRAL LIST

Declaration

I declare under penalty of perjury under the laws of the State of California that the statements below

are true and correct:

●

I am licensed in the State of California in one of the following areas: LCSW, MFT, Clinical

Psychologist or board certified Psychiatrist.

●

I have performed five child custody evaluations within the last three years as specified in Los

Angeles County Rules 5.20 (e)(2)(b) and have attached a list of case names, numbers and dates

completed.*

●

I have read and meet the requirements as specified in the California Rules of Court Section 5.220

(Court-ordered child custody evaluations), 5.225 (Appointment requirements for child custody

evaluators) and 5.230 (Domestic violence training standards for court-appointed child custody

investigators and evaluators) and in the Los Angeles County Court Rules 5.20 (Private Child

Custody Evaluations).

●

I am in compliance with all training required for child custody evaluators by statute, rule of court,

and local rule.

●

I am covered by malpractice insurance and have attached a copy of my policy. I understand that

it is my responsibility to submit to the Court a copy of my policy each year thereafter.

●

I will notify the list administrator within two weeks of my license being revoked or suspended. In

the event I am arrested or have criminal charges brought against me, I will notify the list

administrator within one week of the arrest or charge.

●

I understand that I am required to file the Family Law form, FL-326, in the clerk’s office no later

than ten days after notification of an appointment and before beginning any work on a child

custody evaluation.

●

I understand that any evaluation ordered through this list must be completed and mailed within 10

weeks of receiving the appointment and desired deposit, unless extenuating circumstances arise.

If an extension is required, the evaluator will notify the court, both parties, and the list

administrator by letter. Reasons for the extension are to be described in the letter.

●

I understand that to maintain my inclusion on the list, I must submit this Declaration, evidence of

my malpractice insurance, evidence of completion of annual 8 hour update (CRC 5.225) and DV

training (CRC 5.230), and a copy of my current clinical license annually. Failure to submit these

documents may result in removal from the list.

●

I understand that the Court may remove me from the referral list at any time upon written

notification to the evaluator.

Reasons for removal may include, but are not limited to the

following:

(a)

failure to remain current on training mandated by statute, California Rule of Court, and/or

Los Angeles Superior Court Local Rule;

(b)

submission of work that does not meet the standard of practice for court evaluator (Cal.

Rules of Court, Rule 5.220, 5.225, 5.230);

(c)

failure to submit work in a timely fashion;

(d)

consistent refusal to accept court referrals;

(e)

failure to notify the list administrator if I am arrested or have criminal charges brought

against me.

______________________________

_________________________

(Signature)

(Date)

Case information is confidential and will not be released to any person or entity. The information is only used for internal court-related

purposes incident to the review committees work and is not public information.

Save

Clear

Rev. March 2012

Private Child Custody Evaluators Referral List Page 2

Related Articles

Related forms

Related Categories