ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):

FOR COURT USE ONLY

JV-565

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

                 TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

CASE NAME:

REQUEST FOR ASSISTANCE WITH EXPEDITED PLACEMENT UNDER 
THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN 

CASE NUMBER:

TO

Honorable (name):                                                                        , of (court name):

in (jurisdiction):                                                                         

1.   On (date):   

, this court made orders concerning the expedited placement (under Regulation 

No. 7 of the Interstate Compact on the Placement of Children (ICPC)) of the above-named child with a relative in your jurisdiction. 
A copy of that order is included in attachment 1.

. 

2.  Our records indicate that a copy of the order and all other required documents were sent to the Compact Administrator in your

jurisdiction on (date):

3.

Copies of additional court orders or other documentation are attached (list): 

.

4. The Compact Administrator of your jurisdiction has been in possession of all required documents for the expedited  placement 

request under Regulation No. 7 for more than 20 business days. 

5.  The sending agency has not received notice under ICPC article 3(d) of whether the child may be placed as requested.

REQUEST FOR ASSISTANCE

6.  

Therefore, in an effort to promote cooperation between our jurisdictions and our courts and to continue to promote and protect the 
interests of the children who come before us, I am requesting that your court take whatever steps you deem appropriate or 
necessary, within your jurisdiction and authority—such as holding hearings, taking evidence, or issuing court orders—to assist this 
court in determining the suitability of the proposed placement and to expedite the completion of the home study, as directed by 
Regulation No. 7.

7.  In addition, I request and urge you, consistent with applicable laws, to communicate directly with me to discuss any issues raised
     in this request or the submitted documents.

Superior Court of California, County of: 
Fax No.: 

NOTE: Under ICPC article 5(a), the sending agency will retain jurisdiction over the child and continue to assume financial 
responsibility for the support and maintenance of the child during the period of placement.

Name:
Phone No.: 

E-mail: 

Date:

Form Approved for Optional Use 
Judicial Council of California
JV-565 [Rev. January 1, 2013]

REQUEST FOR ASSISTANCE WITH EXPEDITED PLACEMENT UNDER  
THE INTERSTATE COMPACT ON THE PLACEMENT OF CHILDREN 

JUDICIAL OFFICER

Page 1 of 1

Family Code, § 7900 et seq.;
Cal. Rules of Court, rule 5.616;
ICPC Regulation No.7
www.courts.ca.gov