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

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Here is the text we could read:

1 My contact information (if confidential, use form JV-287):

Child's/Nonminor's date of birth:

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

Fill in child's/nonminor's name and date of birth:

Child's/Nonminor's name:

Court fills in case number when form is filed.

Case Number:

JV-236

Input on Placement in Short-Term
Residential Therapeutic Program or
Community Treatment Facility

Instructions:
Use this form if you do not agree with the placement of a child or
nonminor dependent in a short-term residential therapeutic program or
a community treatment facility. If the agency is asking for the court to
approve the placement without a hearing, you must file this form within
five court days of receiving the report for the hearing. The social
worker or probation officer will inform you that they are requesting that
the court approve the placement without a hearing by sending you form
JV-240, Notice of Request for Approval of Short-Term Residential
Therapeutic Program or Community Treatment Facility Without a
Hearing. The court may approve the placement and cancel the
hearing if you do not file this form with your objection to the
placement within five court days of receiving the report. If you have
a lawyer, talk to your lawyer right away. You can also use this form, if
you want to give any input about the placement.

a. Name:
b. Address:
c. City/State/Zip:
d. Phone:
e. Email:

Your relationship to the child or nonminor dependent:
a.
b.
c.
d.
e.
f.
g.
h.

I am the child or nonminor dependent in this case
Parent or legal guardian
Indian custodian
Lawyer for parent, legal guardian, or Indian custodian
Lawyer for child or nonminor dependent
Representative of Indian tribe
The district attorney, if the youth is a ward of the juvenile court
Other (give relationship):

Yes (date you received report):

5 Why are you completing this form? (check one):

I do not agree to the placement

I want to provide my input on the placement

If you know when the child or nonminor dependent was placed in the program or facility give the
(date):

Did you receive a copy of a report from the social worker or probation officer explaining the reasons for
placement?

Judicial Council of California,
Rev. January 1, 2023, Mandatory Form
Welfare and Institutions Code, §§ 361.22, 727.12
California Rules of Court, rule 5.618

Input on Placement in
Short-Term Residential Therapeutic Program or
Community Treatment Facility

JV-236, Page 1 of 2

Explain why you do not agree, or any input you have about the placement:

Case Number:

7 Your signature

Date:

Type or print your name

Sign your name

Rev. January 1, 2023

Input on Placement in
Short-Term Residential Therapeutic Program or
Community Treatment Facility

JV-236, Page 2 of 2

Input on Placement in Short-Term Residential Therapeutic Program

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): 28
Average fields per page: 14
Reading Level: Grade 7
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.

page_content_right_court_info was JV-236[0].Page1content[0].RightCaption[0].CourtInfo[0] (0.55 conf)
j_page_content_right_caption_name was JV-236[0].Page1content[0].RightCaption[0].ChildsName[0] (0.32 conf)
j_v_page_content_right_b was JV-236[0].Page1content[0].RightCaption[0].ChildsDOB[0] (0.32 conf)
page_content_right_case_number was JV-236[0].Page1content[0].RightCaption[0].CaseNumber[0] (0.35 conf)
j_v_page_content_list_mycontact_namea was JV-236[0].Page1content[0].list1mycontact[0].list1ae[0].namea[0] (0.35 conf)
j_v_page_content_list_mycontact_ae_listbaddress_addressb_tf was JV-236[0].Page1content[0].list1mycontact[0].list1ae[0].listbaddress[0].addressb_tf[0] (0.35 conf)
j_v_page_content_list_mycontact_ae_listccitystatezip_city_state_zip_tf was JV-236[0].Page1content[0].list1mycontact[0].list1ae[0].listccitystatezip[0].CityStateZip_tf[0] (0.38 conf)
j_v_page_content_list_mycontact_ae_listphone_phoned_tf was JV-236[0].Page1content[0].list1mycontact[0].list1ae[0].listphone1[0].phoned_tf[0] (0.35 conf)
j_v_page_content_list_mycontact_ae_listemail_emaile_tf was JV-236[0].Page1content[0].list1mycontact[0].list1ae[0].listemail1[0].emaile_tf[0] (0.35 conf)
j_page_content_item_list__1 was JV-236[0].Page1content[0].item2[0].list2iam[0].relationship[0] (0.35 conf)
j_page_content_item__1 was JV-236[0].Page1content[0].item2[0].listbparent[0].relationship[0] (0.35 conf)
page_content_item_list was JV-236[0].Page1content[0].item2[0].list3ifyouknow[0].relationship[0] (0.35 conf)
page_content_item__1 was JV-236[0].Page1content[0].item2[0].listdlawyerforparent[0].relationship[0] (0.35 conf)
page_content_item__2 was JV-236[0].Page1content[0].item2[0].listlawyerforchild[0].relationship[0] (0.35 conf)
j_page_content_item__2 was JV-236[0].Page1content[0].item2[0].listfrep[0].relationship[0] (0.35 conf)
j_page_content_item__3 was JV-236[0].Page1content[0].item2[0].listfrep[0].relationship[1] (0.35 conf)
j_page_content_item__4 was JV-236[0].Page1content[0].item2[0].listhother[0].relationship[0] (0.35 conf)
page_content_item__3 was JV-236[0].Page1content[0].item2[0].listhother[0].othergiverelationship[0] (0.35 conf)
j_page_content_list_date was JV-236[0].Page1content[0].List3ifyouknowwhen[0].list3[0].DateField1[0] (0.32 conf)
j_page_content_item_list_yes__1 was JV-236[0].Page1content[0].item4[0].list4didyouknow[0].Cb4_Yes[0] (0.32 conf)
j_page_content_item_list__2 was JV-236[0].Page1content[0].item4[0].list4didyouknow[0].yesdate[0] (0.35 conf)
j_page_content_item_list_yes__2 was JV-236[0].Page1content[0].item4[0].list4didyouknow[0].Cb4_Yes[1] (0.32 conf)
j_v_page_content_item_list__1 was JV-236[0].Page1content[0].item5[0].list5[0].why_cb_not[0] (0.32 conf)
j_v_page_content_item_list__2 was JV-236[0].Page1content[0].item5[0].list5[0].why_cb_not[1] (0.32 conf)
j_v_page_header_case_number was JV-236[0].Page2[0].Header2[0].CaseNumber[0] (0.31 conf)
j_v_page_item_lg_bubble was JV-236[0].Page2[0].Item6[0].lgBubble6[0].explainwhy[0] (0.32 conf)
j_v_page_sig_date was JV-236[0].Page2[0].signaturedate[0].SigDate[0] (0.30 conf)
j_v_page was JV-236[0].Page2[0].signaturedate[0].typeorprintname[0] (0.35 conf)

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

Input on Placement in Short-Term Residential Therapeutic Program

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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