Request For Prospective Adoptive Parent Designation
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1
2Request for Prospective Adoptive
Clerk stamps date here when form is filed.
JV-321
Parent Designation
To keep other people from
seeing what you entered on
After filling out this form, bring it to the clerk of the court. If you want to keep
your form, please press the
an address or telephone number confidential, do not write the information on
Clear This Form button at the
this form. Instead, fill out Form JV-322, Confidential Information—Prospective
end of the form when finished.
Adoptive Parent.
1
Information about the person or persons you want to be designated as
prospective adoptive parents:
a.
Name:
Fill in court name and street address:
b.
Name:
Superior Court of California, County of
c. Street address:
d.
City:
State:
Zip:
Telephone number: (
)
e.
2
If you are not a person in
, fill out below.
1
Fill in child's name and date of birth:
a.
Name:
Child's Name:
b.
I am the
child
child’s attorney
other
(specify role):
Date of Birth:
c. Street address:
Fill in case number:
d.
City:
State:
Zip:
Case Number:
e. Telephone number: (
)
3
If you are not the child’s attorney and you know who the child’s attorney is, fill out below.
a.
Name of child’s attorney:
b.
Street address of child’s attorney:
c.
City:
State:
Zip:
d. Telephone number of child’s attorney: (
)
4
The child is 10 years of age or older. Child’s telephone number:
or
Telephone number is confidential.
The child has lived with the person from
(date):
to the present.
5
In order for the person in
1
to become a prospective adoptive parent, the child must be living with that person now.
6
Date of Welfare and Institutions Code section 366.26 hearing:
The person in
should not file this form with the court until a Welfare and Institutions Code section 366.26
1
hearing has been scheduled.
7
The person in
is committed to adopting the child.
1
JV-321,
Page 1 of 2
Judicial Council of California,
Request for Prospective Adoptive
Revised July 1, 2010, Mandatory Form
Parent Designation
Welfare and Institutions Code, §§ 366.24, 366.26(n)
Cal. Rules of Court, rule 5.726
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