Our vision is that every child involved in the child welfare or juvenile justice systems becomes resilient, safe, healthy, and economically secure.

Interested Party Questionnaire

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

Your First Name: Required

Your Last Name: Required

Your Email Address:

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

Child's First Name: Required

Child's Last Name: (1st Initial Only) Required

City: Required

State: Required

Board #: If Known

Meeting Date: If Known

System Contact

What is your role/relationship/responsibility on this case or for these child(ren)?

Explain

What was the date of your last visit with the child(ren) in this case?

Explain

Do you receive updates from anyone regarding the child(ren) or parents in this case?

Explain

Wellbeing

What are the positives in this case?

Explain

Do you have any concerns regarding the child(ren) in this case?

Explain

Do you have any concerns in returning this child/ren home?

Explain

Services For The Child/ren (If Applicable)

Do you know what services are currently being provided to the child(ren)?

Explain

What are the goals for these children and what progress is being made?

Explain

Do you feel the child(ren) are receiving the appropriate services?

Explain

Are there unmet needs for the child(ren)?

Explain

Services For The Parent (If Applicable)

What services are currently being provided to the parent(s)?

Explain

What are the goals for these parents and what progress is being made?

Explain

Do you feel the parent(s) are receiving the appropriate services?

Explain

Are there unmet needs for the parent(s)?

Explain

Additional Information

Is there anything else you would like us to know?

Explain

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

Total file size for all files cannot exceed 17MB.

File Upload (pdf, xls, xlsx, doc, docx, jpg, png, gif, tiff, txt)

By the return of this document online, you attest that the information is true and accurate.

Please call the System Oversight Specialist on this case at the phone number listed in the letter you received. Otherwise call our main office at 402-471-4420 for assistance.

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"The soul is healed by being with children." Fyodor Dostoevsky

"There is no trust more sacred than the one the world holds with children." Kofi A. Annan

"Seek the wisdom of the ages, but look at the world through the eyes of a child." Ron Wild