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Here is the text we could read:

CONFIDENTIAL (DO NOT ATTACH TO PETITION)

GC-212

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

FOR COURT USE ONLY

FAX NO. (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

ATTORNEY FOR (Name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

GUARDIANSHIP OF
(Name):

CONFIDENTIAL GUARDIAN SCREENING FORM

Guardianship of

Person

Estate

CASE NUMBER:

MINOR

HEARING DATE AND TIME:

DEPT.:

The proposed guardian must complete and sign this form. The person requesting appointment of a
guardian must submit the completed and signed form to the court with the guardianship petition.
This form must remain confidential.
How This Form Will Be Used
This form is confidential and will not be a part of the public file in this case. Each proposed guardian must complete and sign a
separate copy of this form under rule 7.1001 of the California Rules of Court. The information provided will be used by the court
and by persons and agencies designated by the court to assist the court in determining whether to appoint the proposed
guardian as guardian. The proposed guardian must respond to each item.

1. a. Proposed guardian (name):

b. Date of birth:
c. Social security number:
e. Telephone numbers: Home:

I am

I am not

d. Driver's license number:

Work:

State:

Other:

required to register as a sex offender under California Penal Code section 290.
(If you checked "I am," explain in Attachment 2.)

I have

I have not been charged with, arrested for, or convicted of a crime deemed to be a felony or a

misdemeanor. (If you checked "I have," explain in Attachment 3.)

(Check here if you have been arrested for drug or alcohol-related offenses.)

I have

I have not had a restraining order or protective order filed against me in the last 10 years.

(If you checked "I have," explain in Attachment 4.)

I am

I am not

receiving services from a psychiatrist, psychologist, or therapist for a mental health–related
issue. (If you checked "I am," explain in Attachment 5.)

Do you, or does any other person living in your home, have a social worker or parole or probation officer assigned to him or her?

Yes

(If you checked "Yes," explain in Attachment 6 and provide the name and address of each
social worker, parole officer, or probation officer.)

Have you, or has any other person living in your home, been charged with, arrested for, or convicted of any form of child abuse,
neglect, or molestation?

(If you checked "Yes," explain in Attachment 7.)

Yes

I am

I am not

aware of any reports alleging any form of child abuse, neglect, or molestation made to any
agency charged with protecting children (e.g., Child Protective Services) or any other law
enforcement agency regarding me or any other person living in my home. (If you checked "I am,"
explain in Attachment 8 and provide the name and address of each agency.)

Have you, or has any other person living in your home, habitually used any illegal substances or abused alcohol?

Yes

(If you checked "Yes," explain in Attachment 9.)

Form Adopted for Mandatory Use
Judicial Council of California
GC-212 [Rev. July 1, 2009]

CONFIDENTIAL GUARDIAN SCREENING FORM
(Probate—Guardianships and Conservatorships)

Page 1 of 2

Probate Code, § 1516;
Family Code, § 3011;
Cal. Rules of Court, rule 7.1001
www.courts.ca.gov

CONFIDENTIAL

GC-212

CASE NUMBER:

MINOR

GUARDIANSHIP OF (Name):

substances or alcohol?

Yes

13.

I have or may have

10. Have you, or has any other person living in your home, been charged with, arrested for, or convicted of a crime involving illegal

11. Do you or does any other person living in your home suffer from mental illness?

(If you checked "Yes," explain in Attachment 11.)

(If you checked "Yes," explain in Attachment 10.)

12. Do you suffer from any physical disability that would impair your ability to perform the duties of guardian?

(If you checked "Yes," explain in Attachment 12.)

an adverse interest that the court may consider to be a risk to, or to have an

I do not have
effect on, my ability to faithfully perform the duties of guardian.
(If you checked "I have or may have," explain in Attachment 13.)

14.

I have

I have not

previously been appointed guardian, conservator, executor, or fiduciary in another proceeding.

(If you checked "I have," explain in Attachment 14.)

15.

I have

I have not

been removed as guardian, conservator, executor, or fiduciary in any other proceeding.
(If you checked "I have," explain in Attachment 15.)

16.

I am

I am not

a private professional fiduciary, as defined in Business and Professions Code section 6501(f).
(If you checked "I am," respond to item 17. If you checked "I am not," go to item 18.)

17.

I am

I am not

currently licensed by the Professional Fiduciaries Bureau of the Department of Consumer
Affairs. My license status and information is stated in item 1 on page 1 of the Professional
Fiduciary Attachment signed by me and attached to the petition that proposes my appointment
as guardian in this matter. (Complete and sign the Professional Fiduciary Attachment and
attach it to the petition, or deliver it to the petitioner for attachment, before the petition is filed.
See item 4d of the petition. Use form GC-210(A-PF)/GC-310(A-PF) for this attachment.)

18.

I am

I am not a responsible corporate officer authorized to act for (name of corporation):

a California nonprofit charitable corporation that meets the requirements for appointment as
guardian of the proposed ward under Probate Code section 2104. I certify that the
corporation's articles of incorporation specifically authorize it to accept appointments as
guardian. (If you checked "I am," explain the circumstances of the corporation's care of,
counseling of, or financial assistance to the proposed ward in Attachment 18.)

19.

I have

I have not

filed for bankruptcy protection within the last 10 years.
(If you checked "I have," explain in Attachment 19.)

MINORS' CONTACT INFORMATION

School (name):

School telephone:

School (name):

School telephone:

School (name):

School telephone:

DECLARATION

Other telephone:

Information on additional minors is attached.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

20. Minor's name:

Home telephone:

21.

Minor's name:
Home telephone:

22.

Minor's name:
Home telephone:

Date:

(TYPE OR PRINT NAME OF PROPOSED GUARDIAN)

(SIGNATURE OF PROPOSED GUARDIAN)*

* Each proposed guardian must fill out and file a separate screening form.

GC-212 [Rev. July 1, 2009]

Page 2 of 2

CONFIDENTIAL GUARDIAN SCREENING FORM
(Probate—Guardianships and Conservatorships)

Confidential Guardian Screening Form

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 82
Average fields per page: 41
Reading Level: Grade 9
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

c_page_p_court_info_county was GC-212[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCounty[0] (0.53 conf)
c_page_p_caption_info_street was GC-212[0].Page1[0].P1Caption[0].CourtInfo[0].CrtStreet[0] (0.36 conf)
page_p_caption_court_info_mailing was GC-212[0].Page1[0].P1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.41 conf)
c_page_p_caption_court_info was GC-212[0].Page1[0].P1Caption[0].CourtInfo[0].CrtBranch[0] (0.36 conf)
g_c_page_p_caption_court_info_crt_city_zip was GC-212[0].Page1[0].P1Caption[0].CourtInfo[0].CrtCityZip[0] (0.35 conf)
c_page_p_form_title was GC-212[0].Page1[0].P1Caption[0].FormTitle[0].Guadianship[0] (0.39 conf)
g_c_page_p_case_number was GC-212[0].Page1[0].P1Caption[0].CaseNumber[0].CaseNumber[0] (0.37 conf)
c_page_p_party_info_text was GC-212[0].Page1[0].P1Caption[0].AttyPartyInfo[0].TextField1[0] (0.40 conf)
c_page_p_party_info_phone was GC-212[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Phone[0] (0.39 conf)
c_page_p_caption_party_info was GC-212[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Fax[0] (0.39 conf)
c_page_p_party_info_email was GC-212[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Email[0] (0.39 conf)
c_page_p_party_info was GC-212[0].Page1[0].P1Caption[0].AttyPartyInfo[0].Attorneyname[0] (0.39 conf)
c_page_p_number_time was GC-212[0].Page1[0].P1Caption[0].CaseNumber2[0].HearingdateandTime[0] (0.40 conf)
c_page_p_number_text_field was GC-212[0].Page1[0].P1Caption[0].CaseNumber2[0].TextField[0] (0.43 conf)
c_page_p_form_title_check__1 was GC-212[0].Page1[0].P1Caption[0].FormTitle2[0].#area[0].CheckBoxCaption[0] (0.40 conf)
c_page_p_form_title_check__2 was GC-212[0].Page1[0].P1Caption[0].FormTitle2[0].#area[1].CheckBoxCaption[1] (0.40 conf)
g_c_page_text_field__1 was GC-212[0].Page1[0].TextField[0] (0.41 conf)
g_c_page_hearing_date was GC-212[0].Page1[0].HearingDate[0] (0.35 conf)
g_c_page_text_field__2 was GC-212[0].Page1[0].TextField[1] (0.41 conf)
g_c_page_text_field__3 was GC-212[0].Page1[0].TextField[2] (0.41 conf)
g_c_page_text_field__4 was GC-212[0].Page1[0].TextField[3] (0.41 conf)
g_c_page_text_field__5 was GC-212[0].Page1[0].TextField[4] (0.41 conf)
g_c_page_text_field__6 was GC-212[0].Page1[0].TextField[5] (0.41 conf)
g_c_page_text_field__7 was GC-212[0].Page1[0].TextField[6] (0.41 conf)
g_c_page_area_check_box__1 was GC-212[0].Page1[0].#area[0].CheckBoxCaption1[0] (0.35 conf)
g_c_page_area_check_box__2 was GC-212[0].Page1[0].#area[0].CheckBoxCaption1[1] (0.35 conf)
g_c_page_area_check_box__3 was GC-212[0].Page1[0].#area[1].CheckBoxCaption2[0] (0.35 conf)
g_c_page_area_check_box__4 was GC-212[0].Page1[0].#area[1].CheckBoxCaption2[1] (0.35 conf)
g_c_page_area_check_b was GC-212[0].Page1[0].#area[2].CheckB12[0] (0.37 conf)
g_c_page_area_check_box__5 was GC-212[0].Page1[0].#area[3].CheckBoxCaption3[0] (0.35 conf)
g_c_page_area_check_box__6 was GC-212[0].Page1[0].#area[3].CheckBoxCaption3[1] (0.35 conf)
g_c_page_area_check_box__7 was GC-212[0].Page1[0].#area[4].CheckBoxCaption4[0] (0.35 conf)
g_c_page_area_check_box__8 was GC-212[0].Page1[0].#area[4].CheckBoxCaption4[1] (0.35 conf)
g_c_page_area_check_box__9 was GC-212[0].Page1[0].#area[5].CheckBoxCaption5[0] (0.35 conf)
g_c_page_area_check_box__10 was GC-212[0].Page1[0].#area[5].CheckBoxCaption5[1] (0.35 conf)
g_c_page_area_check_box__11 was GC-212[0].Page1[0].#area[6].CheckBoxCaption6[0] (0.35 conf)
g_c_page_area_check_box__12 was GC-212[0].Page1[0].#area[6].CheckBoxCaption6[1] (0.35 conf)
g_c_page_area_check_box__13 was GC-212[0].Page1[0].#area[7].CheckBoxCaption7[0] (0.35 conf)
g_c_page_area_check_box__14 was GC-212[0].Page1[0].#area[7].CheckBoxCaption7[1] (0.35 conf)
g_c_page_area_check_box__15 was GC-212[0].Page1[0].#area[8].CheckBoxCaption8[0] (0.35 conf)
g_c_page_area_check_box__16 was GC-212[0].Page1[0].#area[8].CheckBoxCaption8[1] (0.35 conf)
c_page_title_party_name was GC-212[0].Page2[0].PxCaption[0].TitlePartyName[0].Guadianship[0] (0.36 conf)
g_c_page_px_case_number was GC-212[0].Page2[0].PxCaption[0].CaseNumber[0].CaseNumber[0] (0.38 conf)
g_c_page_area_check_box__17 was GC-212[0].Page2[0].#area[0].CheckBoxCaption9[0] (0.35 conf)
g_c_page_area_check_box__18 was GC-212[0].Page2[0].#area[0].CheckBoxCaption9[1] (0.35 conf)
g_c_page_area_check_box__19 was GC-212[0].Page2[0].#area[1].CheckBoxCaption10[0] (0.35 conf)
g_c_page_area_check_box__20 was GC-212[0].Page2[0].#area[1].CheckBoxCaption10[1] (0.35 conf)
g_c_page_area_check_box__21 was GC-212[0].Page2[0].#area[2].CheckBoxCaption11[0] (0.35 conf)
g_c_page_area_check_box__22 was GC-212[0].Page2[0].#area[2].CheckBoxCaption11[1] (0.35 conf)
g_c_page_area_check_box__23 was GC-212[0].Page2[0].#area[3].CheckBoxCaption12[0] (0.35 conf)
g_c_page_area_check_box__24 was GC-212[0].Page2[0].#area[3].CheckBoxCaption12[1] (0.35 conf)
g_c_page_area_check_box__25 was GC-212[0].Page2[0].#area[4].CheckBoxCaption13[0] (0.35 conf)
g_c_page_area_check_box__26 was GC-212[0].Page2[0].#area[4].CheckBoxCaption13[1] (0.35 conf)
g_c_page_area_check_box__27 was GC-212[0].Page2[0].#area[5].CheckBoxCaption14[0] (0.35 conf)
g_c_page_area_check_box__28 was GC-212[0].Page2[0].#area[5].CheckBoxCaption14[1] (0.35 conf)
g_c_page_area_check_box__29 was GC-212[0].Page2[0].#area[6].CheckBoxCaption15[0] (0.35 conf)
g_c_page_area_check_box__30 was GC-212[0].Page2[0].#area[6].CheckBoxCaption15[1] (0.35 conf)
g_c_page_area_check_box__31 was GC-212[0].Page2[0].#area[7].CheckBoxCaption16[0] (0.35 conf)
g_c_page_area_check_box__32 was GC-212[0].Page2[0].#area[7].CheckBoxCaption16[1] (0.35 conf)
g_c_page_area_check_box__33 was GC-212[0].Page2[0].#area[8].CheckBoxCaption17[0] (0.35 conf)
g_c_page_area_check_box__34 was GC-212[0].Page2[0].#area[8].CheckBoxCaption17[1] (0.35 conf)
g_c_page_text_field__8 was GC-212[0].Page2[0].TextField[0] (0.41 conf)
g_c_page_area_check_box__35 was GC-212[0].Page2[0].#area[9].CheckBoxCaption18[0] (0.35 conf)
g_c_page_area_check_box__36 was GC-212[0].Page2[0].#area[9].CheckBoxCaption18[1] (0.35 conf)
g_c_page_text_field__9 was GC-212[0].Page2[0].TextField[1] (0.41 conf)
g_c_page_text_field__10 was GC-212[0].Page2[0].TextField[2] (0.41 conf)
g_c_page_text_field__11 was GC-212[0].Page2[0].TextField[3] (0.41 conf)
g_c_page_text_field__12 was GC-212[0].Page2[0].TextField[4] (0.41 conf)
g_c_page_text_field__13 was GC-212[0].Page2[0].TextField[5] (0.41 conf)
g_c_page_text_field__14 was GC-212[0].Page2[0].TextField[6] (0.41 conf)
g_c_page_text_field__15 was GC-212[0].Page2[0].TextField[7] (0.41 conf)
g_c_page_text_field__16 was GC-212[0].Page2[0].TextField[8] (0.41 conf)
g_c_page_text_field__17 was GC-212[0].Page2[0].TextField[9] (0.41 conf)
g_c_page_text_field__18 was GC-212[0].Page2[0].TextField[10] (0.41 conf)
g_c_page_text_field__19 was GC-212[0].Page2[0].TextField[11] (0.41 conf)
g_c_page_text_field__20 was GC-212[0].Page2[0].TextField[12] (0.41 conf)
g_c_page_text_field__21 was GC-212[0].Page2[0].TextField[13] (0.41 conf)
g_c_page_text_field__22 was GC-212[0].Page2[0].TextField[14] (0.41 conf)
g_c_page_text_field__23 was GC-212[0].Page2[0].TextField[15] (0.41 conf)
g_c_page_area_date was GC-212[0].Page2[0].#area[10].Date[0] (0.33 conf)
g_c_page_area_print_name was GC-212[0].Page2[0].#area[10].PrintName[0] (0.34 conf)
g_c_page_check_bo was GC-212[0].Page2[0].CheckBo[0] (0.37 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

c_page_p_court_info_county
c_page_p_caption_info_street
page_p_caption_court_info_mailing
c_page_p_caption_court_info
g_c_page_p_caption_court_info_crt_city_zip
c_page_p_form_title
g_c_page_p_case_number
c_page_p_party_info_text
c_page_p_party_info_phone
c_page_p_caption_party_info
c_page_p_party_info_email
c_page_p_party_info
c_page_p_number_time
c_page_p_number_text_field
c_page_p_form_title_check__1
c_page_p_form_title_check__2
g_c_page_text_field__1
g_c_page_hearing_date
g_c_page_text_field__2
g_c_page_text_field__3
g_c_page_text_field__4
g_c_page_text_field__5
g_c_page_text_field__6
g_c_page_text_field__7
g_c_page_area_check_box__1
g_c_page_area_check_box__2
g_c_page_area_check_box__3
g_c_page_area_check_box__4
g_c_page_area_check_b
g_c_page_area_check_box__5
g_c_page_area_check_box__6
g_c_page_area_check_box__7
g_c_page_area_check_box__8
g_c_page_area_check_box__9
g_c_page_area_check_box__10
g_c_page_area_check_box__11
g_c_page_area_check_box__12
g_c_page_area_check_box__13
g_c_page_area_check_box__14
g_c_page_area_check_box__15
g_c_page_area_check_box__16
c_page_title_party_name
g_c_page_px_case_number
g_c_page_area_check_box__17
g_c_page_area_check_box__18
g_c_page_area_check_box__19
g_c_page_area_check_box__20
g_c_page_area_check_box__21
g_c_page_area_check_box__22
g_c_page_area_check_box__23
g_c_page_area_check_box__24
g_c_page_area_check_box__25
g_c_page_area_check_box__26
g_c_page_area_check_box__27
g_c_page_area_check_box__28
g_c_page_area_check_box__29
g_c_page_area_check_box__30
g_c_page_area_check_box__31
g_c_page_area_check_box__32
g_c_page_area_check_box__33
g_c_page_area_check_box__34
g_c_page_text_field__8
g_c_page_area_check_box__35
g_c_page_area_check_box__36
g_c_page_text_field__9
g_c_page_text_field__10
g_c_page_text_field__11
g_c_page_text_field__12
g_c_page_text_field__13
g_c_page_text_field__14
g_c_page_text_field__15
g_c_page_text_field__16
g_c_page_text_field__17
g_c_page_text_field__18
g_c_page_text_field__19
g_c_page_text_field__20
g_c_page_text_field__21
g_c_page_text_field__22
g_c_page_text_field__23
g_c_page_area_date
g_c_page_area_print_name
g_c_page_check_bo

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Confidential Guardian Screening Form

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02