Application For Court-Appointed Juvenile Justice Expert Panel {JC-E-663}

SUPERIOR COURT OF CALIFORNIA COUNTY OF SACRAMENTO APPLICATION FOR COURT-APPOINTED JUVENILE JUSTICE EXPERT PANEL The Superior Court of California, County of Sacramento has established a panel of psychiatric and psychological experts to evaluate/assess minors in juvenile justice proceedings and if subpoenaed to do so, to testify during trials. Minimum Standards for Court-Appointed Juvenile Justice Expert: California Rules of Court, rule 5.645(d)(1)(B), sets forth the minimum qualifications an applicant must have to be appointed as an expert. The expert must be either: (a.) A licensed psychiatrist who has successfully completed four (4) years of medical school and either four (4) years of general psychiatry residency, including one (1) year of internship and two (2) years of child and adolescent fellowship training, or three (3) years of general psychiatry residency, including one (1) year of internship and one (1) year of residency that focus on children and adolescents and one (1) year of child and adolescent fellowship training; or A clinical, counseling, or school psychologist who has received a doctoral degree in psychology from an educational institution accredited by an organization recognized by the Council for Higher Education Accreditation and who is licensed as a psychologist. (b.) In addition to either of these qualifications, pursuant to California Rules of Court, rule 5.645(d)(1)(C)(i)-(vi), the expert whether a licensed psychiatrist or psychologist must: i. ii. iii. iv. v. vi. Possess demonstrable professional experience addressing child and adolescent developmental issues, including the emotional, behavioral, and cognitive impairments of children and adolescents; Have expertise in the cultural and social characteristics of children and adolescents; Possess a curriculum vitae reflecting training and experience in the forensic evaluation of children; Be familiar with juvenile competency standards and accepted criteria used in evaluating juvenile competence; Possess a comprehensive understanding of effective interventions as well as treatment, training, and programs for the attainment of competency available to children and adolescents; and Be proficient in the language preferred by the child, or if that is not feasible, employ the services of a certified interpreter and use assessment tools that are linguistically and culturally appropriate for the child. Fee for Service: The current rate for juvenile delinquency cases is $125 per hour, with a cap of $1000 per report. Application Instructions: Complete, sign, date, and return the application with the required documentation (as outlined on page 4 of the application) to: Juvenile Court Administration Juvenile Justice Courthouse 9605 Kiefer Boulevard Sacramento, CA 95827 Contact for additional information: Shelby Wineinger, Director of Operations (916) 875-5027 or Wineins@saccourt.ca.gov Application Deadline: This is a continuous posting and applications will be accepted until further notice. American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA COUNTY OF SACRAMENTO APPLICATION FOR COURT-APPOINTED JUVENILE JUSTICE EXPERT PANEL Name (last, first, middle initial) Professional License Number Mailing Address City, State and Zip Code Telephone Number Professional Title Fax Number Cellular or Alternate Telephone Number E-mail Address 1. Types of Evaluations: You are applying for the Court-Appointed Juvenile Justice Expert Panel only. Please indicate which types of evaluations you wish to be appointed to perform: COMPETENCY GENERAL DISPOSITIONS DISPOSITION SEX OFFENSES 2. Language: In addition to English fluency, can you conduct evaluations in other languages? Yes No If yes, please indicate language(s): PSYCHOLOGISTS: a. School granting Ph.D. or Psy.D.: Graduation Date: b. Is educational institution accredited by an organization recognized by the Council for Higher Education Accreditation? Yes No c. Date California Psychology License received: 3. 4. LICENSED PSYCHIATRIST/MEDICAL DOCTORS: a. Medical school granting M.D.: Graduation Date: b. Date California Medical License received: c. Date of Board Certification: Mandatory JC-E-663 Revised: 09/08/17 APPLICATION FOR COURT-APPOINTED JUVENILE JUSTICE EXPERT PANEL Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Applicant's Name: 5. Evaluation reports and experience regarding courtroom professional testimonials: a. Have you written psychological/psychiatric evaluations for court or counsel? b. Are you willing and able to submit written psychiatric/psychological reports to the Court under the time constraints determined by the Court? c. Have you testified as an expert witness: Yes Yes Yes No No No 6. Location of Evaluations: a. Are you willing to conduct evaluations of minors in-custody? b. Are you willing to conduct evaluations of minors in your office? Yes Yes Yes Case Disposition No No No 7. Have you ever been convicted by any court of an offense? Offense* Date Where *Do not include minor traffic violations, any offense committed prior to your 18 birthday which was adjudicated in a juvenile court or under a youth offender law, or any offense sealed or set aside under Penal Code §1203.4 et seq. th 8. References: Please provide three (3) references that have direct experience with your work as it relates to this appointment (i.e., an attorney or judge for whom you have prepared an evaluation report for or testified before, etc.). Reference 1: Name: Title: Address: Address: Telephone No.: Reference 2: Name: Title: Address: Address: Telephone No.: Reference 3: Name: Title: Address: Address: Telephone No.: Mandatory JC-E-663 Revised: 09/08/17 APPLICATION FOR COURT-APPOINTED JUVENILE JUSTICE EXPERT PANEL Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Applicant's Name: I certify that all statements made on this application for initial appointment are true and complete to the best of my knowledge. I understand that any false, incomplete or incorrect statement may result in my disqualification from the selection process for the Court-Appointed Juvenile Justice Expert Panel (the Panel), from the Panel itself or both. I authorize the Superior Court of California, Sacramento County (the Court), to investigate my references, work record, education, and any other matters relating to my suitability for appointment to the Panel. I authorize my former and current employers and educational institutions I have attended to release to the Court any informat