Here is the text we could read:
EVALUATOR (name and address):
FOR COURT USE ONLY
FL-325
TELEPHONE NO.:
E-MAIL ADDRESS (optional):
FAX NO.:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
DECLARATION OF COURT-CONNECTED CHILD CUSTODY
EVALUATOR REGARDING QUALIFICATIONS
1. I, (name): , declare that if I appeared in court and were sworn, I would
testify to the truth of the facts in this declaration.
2. As of (date): , I am a court-connected child custody evaluator or a person who supervises court-
connected child custody evaluators for the above court.
3.
I submit this form to indicate compliance with all applicable requirements for a court-connected child custody evaluator under rule
5.225 of the California Rules of Court for (specify year): .
LICENSING REQUIREMENTS
4.
a.
b.
a.
5.
I am licensed as a psychologist, marriage and family therapist, clinical social worker, or professional clinical counselor
qualified to assess couples and families; or
I am licensed as a physician and I am a board-certified psychiatrist, or I have completed a residency in psychiatry; or
I am not licensed, but I am eligible to be certified by the court to perform court-connected child custody evaluations
under Family Code section 3110.5(c)(5) and rule 5.225(c)(2)(A) because
I meet the requirements for a court-connected child custody evaluator under rule 5.225(j); and
I am being supervised by a court-connected child custody evaluator who has complied with all the requirements for
court-connected child custody evaluators under rule 5.225; and
b.
I request that the court certify that I meet all the requirements for a court-connected evaluator under rule 5.225.
6.
I am not licensed or eligible for certification as indicated in item 4 or 5.
NOTICE: If item 6 is checked, the court may not appoint the person to perform a child custody evaluation in this
case unless, under Family Code section 3110.5(d) and rule 5.225(c)(2)(B), all the following criteria have been met:
The court determined that there are no licensed or certified evaluators who are willing and available, within a
reasonable period of time, to perform child custody evaluations;
The parties have stipulated that the person may conduct the child custody evaluation; and
(1)
(2)
(1)
(2)
(3)
The court approves the person's appointment.
EDUCATION AND TRAINING REQUIREMENTS
7.
I have completed
a.
b.
c.
the basic and advanced domestic violence training requirements for a court-connected child custody evaluator under
rule 5.225(e); and
the 40 hours of education and training requirements for a court-connected evaluator under rule 5.225(d); or
at least 20 of the 40 hours of the education and training requirements for a court-connected evaluator. I will complete the
remaining hours of education and training required by rule 5.225(d) within 12 months of conducting my first evaluation
as a court-connected child custody evaluator.
CONTINUING EDUCATION AND TRAINING REQUIREMENTS
8.
a.
I have recently completed the initial education and training in item 7. I must complete the continuing education and
training requirements of rule 5.225(i) by (specify date): (within 18 months
after completing the initial education and training described in items 7a and 7b).
Form Adopted for Mandatory Use
Judicial Council of California
FL-325 [Rev. Jan. 1, 2020]
DECLARATION OF COURT-CONNECTED CHILD CUSTODY
EVALUATOR REGARDING QUALIFICATIONS
Family Code, ยงยง 1816, 3110.5;
Cal. Rules of Court, rules 5.225, 5.230
www.courts.ca.gov
Page 1 of 2
EVALUATOR'S NAME:
FL-325
8.
b.
I have completed the continuing education and training requirements within the 12-month period immediately preceding
the date I signed this declaration, as follows:
(1)
(2)
9.
a.
b.
10.
8 hours of update training requirements covering the subjects described in rule 5.225(d)
4 hours of domestic violence update training under rule 5.230
I have complied with the experience requirements for a court-connected child custody evaluator specified in rule 5.225(g)
because I participated in the completion of four court-appointed child custody evaluations in the preceding three years as
follows:
I independently conducted and completed the child custody evaluations as stated in rule 5.225(g)(1)(A); or
I materially assisted another evaluator as stated in rule 5.225(g)(1)(B).
I have complied with the experience requirements for those who supervise court-connected child custody evaluators because
I conducted or materially assisted in the completion of four court-connected child custody evaluations in the preceding three
years as stated in rule 5.225(g)(3).
11.
I have not complied with the experience requirements for child custody evaluators stated in rule 5.225(g)(1).
NOTICE: If item 11 is checked, the court may not appoint a court-connected evaluator to perform a child custody
evaluation unless, under rule 5.225(g)(2), all the following criteria have been met:
(1)
The court determined that there are no child custody evaluators who meet the experience requirements for
child custody evaluators who are willing and available, within a reasonable period of time, to perform child
custody evaluations;
(2)
The parties have stipulated that the person may conduct the evaluation; and
(3)
The court approves the person's appointment.
USE OF INTERNS
12.
I intend to use interns to assist with the child custody evaluation in the manner disclosed and agreed to by the parties and
attorneys in the case. Each intern will have complied with the criteria of rule 5.225(m) and will work under my supervision at
all times.
All court-connected child custody evaluators must submit this form to the court executive officer or his or her
designee. Court-connected child custody evaluators appointed as of January 1 of a given year must submit this form
by January 30 of that year. Court-connected evaluators beginning practice after January 1 must submit this form
before beginning any work on the first child custody evaluation and by January 30 of every year thereafter. (Cal.
Rules of Court, rule 5.225(l)(1)(A).)
NOTICE
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
(TYPE OR PRINT NAME)
(SIGNATURE OF DECLARANT)
BASED ON THE FOREGOING, THE COURT CERTIFIES THAT THE ABOVE PERSON IS A COURT-CONNECTED CHILD
CUSTODY EVALUATOR WHO MEETS ALL THE QUALIFICATIONS FOR COURT-CONNECTED EVALUATORS AS
SPECIFIED BY THE JUDICIAL COUNCIL IN RULE 5.225 OF THE CALIFORNIA RULES OF COURT.
CERTIFICATION
Date:
Date:
FL-325 [Rev. Jan. 1, 2020]
DECLARATION OF COURT-CONNECTED CHILD CUSTODY
EVALUATOR REGARDING QUALIFICATIONS
Page 2 of 2
JUDGE
COMMISSIONER
Declaration of Court-connected Child Custody Evaluator Regarding Qualifications
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): 37
- Average fields per page: 18
- Reading Level: Grade 11
- LIST Grouping(s):
CO-00-00-00-00.
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.
f_l_page_check_box__1
was FL-325[0].Page1[0].CheckBox1[0] (0.56 conf)f_l_page_check_box__2
was FL-325[0].Page1[0].CheckBox19[0] (0.41 conf)f_l_page_cb_choice__1
was FL-325[0].Page1[0].CBChoice1_cb[0] (0.33 conf)f_l_page_cb_choice__2
was FL-325[0].Page1[0].CBChoice1_cb[1] (0.33 conf)f_page_p_party_info_name
was FL-325[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Name[0] (0.41 conf)f_page_p_party_info_phone
was FL-325[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Phone[0] (0.41 conf)f_l_page_p_party_info
was FL-325[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Fax[0] (0.41 conf)f_page_p_party_info_email
was FL-325[0].Page1[0].p1Caption[0].AttyPartyInfo[0].Email[0] (0.41 conf)f_l_page_p_info_county
was FL-325[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCounty[0] (0.37 conf)f_l_page_p_info_street
was FL-325[0].Page1[0].p1Caption[0].CourtInfo[0].CrtStreet[0] (0.37 conf)f_l_page_p_caption_info
was FL-325[0].Page1[0].p1Caption[0].CourtInfo[0].CrtMailingAdd[0] (0.41 conf)f_l_page_p_caption_court_info_crt_city_zip
was FL-325[0].Page1[0].p1Caption[0].CourtInfo[0].CrtCityZip[0] (0.39 conf)f_l_page_p_court_branch
was FL-325[0].Page1[0].p1Caption[0].CourtInfo[0].CrtBranch[0] (0.37 conf)f_l_page_evaluator_name
was FL-325[0].Page1[0].EvaluatorName[0] (0.35 conf)f_l_page_date_field__1
was FL-325[0].Page1[0].DateField1[0] (0.37 conf)f_l_page_text_field
was FL-325[0].Page1[0].TextField6[0] (0.34 conf)f_l_page_check_box__3
was FL-325[0].Page1[0].CheckBox1[1] (0.41 conf)f_l_page_check_box__4
was FL-325[0].Page1[0].CheckBox19[1] (0.41 conf)f_l_page_cb_choice__3
was FL-325[0].Page1[0].CBChoice1_cb[2] (0.33 conf)f_l_page_check_box__5
was FL-325[0].Page1[0].CheckBox19[2] (0.41 conf)f_l_page_check_box__6
was FL-325[0].Page1[0].CheckBox19[3] (0.41 conf)f_l_page_date_field__2
was FL-325[0].Page1[0].DateField2[0] (0.37 conf)f_l_page_fill_text__1
was FL-325[0].Page2[0].FillText1140[0] (0.42 conf)page_caption_title_party_name
was FL-325[0].Page2[0].pxCaption[0].TitlePartyName[0].EvaluatorName[0] (0.36 conf)f_l_page_fill_text__2
was FL-325[0].Page2[0].FillText56[0] (0.42 conf)f_l_page_check_box__7
was FL-325[0].Page2[0].CheckBox19[0] (0.41 conf)f_l_page_check_box__8
was FL-325[0].Page2[0].CheckBox1[0] (0.41 conf)f_l_page_check_box__9
was FL-325[0].Page2[0].CheckBox1[1] (0.41 conf)f_l_page_check_box__10
was FL-325[0].Page2[0].CheckBox19[1] (0.41 conf)f_l_page_check_box__11
was FL-325[0].Page2[0].CheckBox1[2] (0.41 conf)f_l_page_check_box__12
was FL-325[0].Page2[0].CheckBox1[3] (0.41 conf)f_l_page_check_box__13
was FL-325[0].Page2[0].CheckBox19[2] (0.41 conf)f_l_page_check_box__14
was FL-325[0].Page2[0].CheckBox19[3] (0.41 conf)f_l_page_check_box__15
was FL-325[0].Page2[0].CheckBox19[4] (0.41 conf)f_l_page_fill_text__3
was FL-325[0].Page2[0].FillText1140[1] (0.42 conf)f_l_page_area_judge_cb__1
was FL-325[0].Page2[0].#area[0].judge_cb[0] (0.36 conf)f_l_page_area_judge_cb__2
was FL-325[0].Page2[0].#area[1].judge_cb[1] (0.36 conf)
We've done our best to group similar variables togther to avoid overwhelming the user.
Suggested Screen 0:
f_l_page_check_box__1
f_l_page_check_box__2
f_l_page_cb_choice__1
f_l_page_cb_choice__2
f_page_p_party_info_name
f_page_p_party_info_phone
f_l_page_p_party_info
f_page_p_party_info_email
f_l_page_p_info_county
f_l_page_p_info_street
f_l_page_p_caption_info
f_l_page_p_caption_court_info_crt_city_zip
f_l_page_p_court_branch
f_l_page_evaluator_name
f_l_page_date_field__1
f_l_page_text_field
f_l_page_check_box__3
f_l_page_check_box__4
f_l_page_cb_choice__3
f_l_page_check_box__5
f_l_page_check_box__6
f_l_page_date_field__2
f_l_page_fill_text__1
page_caption_title_party_name
f_l_page_fill_text__2
f_l_page_check_box__7
f_l_page_check_box__8
f_l_page_check_box__9
f_l_page_check_box__10
f_l_page_check_box__11
f_l_page_check_box__12
f_l_page_check_box__13
f_l_page_check_box__14
f_l_page_check_box__15
f_l_page_fill_text__3
f_l_page_area_judge_cb__1
f_l_page_area_judge_cb__2
Create an Interactive Version of this Form:
The Weaver creates a draft guided interview from a template form, like the one provided here. You can use the link below to open this form in the Weaver.
To learn more, read "Weaving" your form into a draft interview.
Launch Form in Weaver