Request For Prospective Adoptive Parent Designation Page 2
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1
2Case Number:
Child’s name:
8
The person in
1
has (check all that apply):
a.
Applied for an adoptive home study
b.
In a case in which tribal customary adoption is the permanent plan, been identified by the Indian child’s
tribe as the prospective adoptive parent.
c.
Cooperated with an adoptive home study
d.
Signed an adoptive placement agreement
e.
Requested de facto parent status
f.
Been designated by the juvenile court or the licensed adoption agency as the adoptive parent
g.
Discussed a postadoption contact agreement with the social worker, child’s attorney, child’s Court
Appointed Special Advocate (CASA) volunteer, adoption agency, or court
h.
Worked to overcome any impediments that have been identified by the California Department of Social
Services or the licensed adoption agency
i.
Attended any of the classes required of prospective adoptive parent
Taken other steps toward adopting the child (explain):
j.
If you need more space, attach a sheet of paper and write “JV-321, Item 8—Steps Toward Adoption” at
Number of pages attached:
the top.
I declare under penalty of perjury under the laws of the State of California that the information in items 1 through 8
is true and correct, which means if I lie on this form, I am committing a crime.
Date:
Type or print your name
Sign your name
Type or print your name
Sign your name
JV-321,
Revised July 1, 2010
Request for Prospective Adoptive
Page 2 of 2
Parent Designation
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