Probation Officer

"*" indicates required fields

User Information

What is reported in this questionnaire may be included in the local board’s report to the legal parties to the case.

Your Name*

First Last

If responding for more than one youth, use the oldest youth’s first name and last initial.

Name of Youth*

First Last (1st Initial Only)

Address*

City State

Board #: If Known

Meeting Date: If Known

Wellbeing

How is the youth currently doing in their placement?

What positive changes and behaviors has the youth been engaging in/demonstrating?

What are your concerns regarding the youth at this point?

To your knowledge, has the youth ever been a victim of sex or labor trafficking?

Visitation

Is the youth regularly talking to or seeing their parent(s)/guardian(s)?

Is the youth regularly talking to or seeing all their siblings (if there are any)?

When was your last phone visit with the youth?

When was your last face to face (virtual or in-person) visit with the youth?

Placement

What is the current transition plan? When do you expect that transition will occur?

If the youth is in an out of state placement, please explain why? (Did all in-state placements deny, was a specific placement ordered to be referred to by the Judge, specific needs could not be met in-state, etc.)

Additional Information

Is there any other information that you believe is pertinent for us to consider regarding this case?

Although not required, if you would like to submit any additional related documents you may do so below:

Accepted file types: pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt, Max. file size: 64 MB.

By the return of this document you attest that the information is true and accurate. If returned by email, your email may serve in lieu of your signature.