School Report {RI-PR096}

SUPERIOR COURT OF CALIFORNIA, COUNTY OF RIVERSIDE PALM SPRINGS 3255 E. Tahquitz Canyon Wy., Palm Springs, CA 92262 RIVERSIDE 4050 Main St., Riverside, CA 925 01 TEMECULA 41002 County Center Dr., #100, Temecula, CA 92591 RI - PR 096 ATTORNEY OR PARTY WITHOUT ATTORNEY ( Name, State Bar Number and Address) FOR COURT USE ONLY (CONFIDENTIAL) TELEPHONE NO.: FAX NO. (Optional): E - MAIL ADDRESS (Optional): ATTORNEY FOR (Name ): IN THE MATTER OF: CASE NUMBER: SCHOOL REPORT Note to Petitioner: Please complete below where indicated. A separate form is required for each minor. NAME AND ADDRESS OF SCHOOL: NAME OF CHILD: DATE OF BIRTH: AGE: GRADE: Dear Principal, Our department is currently conducting an investigation in regard to the minor whose name appears above. Therefore, we are requesting that you co mplete the information requested below and return the form to our department. Your cooperation is appreciated. We assure you that the information you provide us will be used with discretion. use only. Your prompt return of this information is requested. Thank you for your cooperation in this matter. Petitioner: Do not complete below this line. PLEASE ATTACH AVAILABLE GRADE TRANSCRIPTS AND/OR REPORT CARDS Attendance satisfactory? Yes No Truancies: Page 1 of 2 Adopted for Mandatory Use Riverside Superior Court Form RI - PR 096 [Rev. 01/01/19 ] SCHOOL REPORT Probate Code 1513 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com IN THE MATTER OF: CASE NUMBER: Health and Physical Condition General Health: Vision: Hearing: Physical Handicap: Disease Record: Is the Child in Special Education Classes? Yes No Please rat e the following accordingly: 4 - Superior 3 - Average 2 - Below Average 1 - Failure Appears contented: Neatly and cleanly dressed: Has good work habits: Gets along with others: Accepts Responsibility: Uses his/her abilities: Good manual coordination: Obedient and cooperative: Good health habits: Brings work material regularly: To your knowledge has the child been referred for psychological/psychiatric testing? Yes No If Yes, please include report, if available. If not, the name, address and phone number of the examiner: Remed ial measures attempted: Comments on contact with proposed guardians and/or parents: Date: (PRINT NAME AND TITLE) (SIGNATURE) Page 2 o f 2 Adopted for Mandatory Use Riverside Superior Court Form RI - PR 096 [Rev. 01/01/19 ] SCHOOL REPORT Probate Code 1513 riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com