STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

ORDER OF DISPOSITION
(CHILD PROTECTIVE PROCEEDINGS)

ORDER 

 

 OF 
 

CASE NO.

PETITION NO.

JUDGE

Court address

Court telephone no.

In the matter of 

First and last name(s), alias(es)

1. Date of hearing: 

 

  Judge/Referee: 

 2. Removal date: 

 

 

 (Specify for each child if different.)

3. An adjudication was held and the child(ren) was/were found to come within the jurisdiction of the court.
 

 4. Release of the parental rights to 

Name(s) of child(ren)

 was executed by

   

Name(s) of parent(s)

 pursuant to the adoption code on 

Date

 5. This hearing is being conducted under MCR 3.974(D)(1) for an Indian child who was removed from the home. The 
    Indian child removal hearing 
   

 was held with this hearing. 

 was previously held. 

 is scheduled for 

 . 

 

 

 . 

THE COURT FINDS:

 6. Notice of hearing was given as required by law.

7. The lawyer-guardian ad litem 

 has 

 has not  complied with the requirements of MCL 712A.17d. 

 a. There is probable cause to believe the legal/putative father(s) is/are:

 8. 
            (Name each child, his/her father, and whether legal or putative.)

 b. The putative father of 
 is unknown and cannot be identified.
   
   
 c.  The putative father was notified as required by law and failed to establish paternity within the time set by the 
            court. The putative father waives all rights to further notice, including the right to notice of termination of parental 
            rights and the right to an attorney.

 

9. The court has considered the case service plan and other evidence presented. The findings below are specific to this 
  case and are based upon this hearing and
  

 the following report(s): 

 

Identify report(s) and date(s) of report(s)

  Specific conditions reviewed on the record as required by MCL 712A.18f(4) were
  a. compliance with the case service plan with respect to services provided or offered to the child and his or her parent(s), 
 
      guardian, or legal custodian and whether the parent(s), guardian, or legal custodian complied with and benefited  
      from those services.
  b. compliance with the case service plan with respect to parenting time with the child and whether parenting time did 
      not occur or was infrequent and the reasons why.
  c.  the extent to which the parent(s), guardian, or legal custodian complied with each provision of the case service plan,
      prior court orders, and any agreement between the parent(s), guardian, or legal custodian and the agency.
  d. likely harm to the child if the child continued to be separated from his or her parent(s), guardian, or legal custodian.
  e. likely harm to the child if the child was returned to his or her parent(s), guardian, or legal custodian.

Note: If it comes to the court’s attention or new allegations are made during this hearing that require the removal of the child(ren), removal must be done 
in accordance with MCR 3.974. 

Approved, SCAO
Form JC 17, Rev. 12/22
MCL 400.55(h), MCL 400.203, MCL 712A.13a, MCL 712A.18, 
MCL 712A.18f, MCL 712A.19, MCL 712A.19a(2), MCL 712A.20, PL 96-272, 
42 USC 670 et seq., MCR 3.921(B), MCR 3.973, MCR 3.976(B)(1)
Page 1 of 5

Use Note: Use this form when a release has been executed under the 
adoption code after adjudication and before the dispositional hearing.

Reference  Note:  The  term  “department”  refers  to  the  Michigan 
Department of Health and Human Services.

 

 
 

 

 
 
 
 

 
 
 
 
 
 
 
 
 
 

JIS Code: DSPOrder of Disposition (Child Protective Proceedings) 
Page 2 of 5

(12/22) 

Case No. 
 

10.  Return of the juvenile to his or her parent 
 

  society.

 would 

 would not  cause a substantial risk of harm to the juvenile or 

OR

 b. Consistent with the circumstances, reasonable efforts were made to prevent or eliminate removal of the 

 c.  The child(ren) is/are Indian, and the court finds by clear and convincing evidence and the testimony of a 

 a. Consistent with the circumstances, reasonable efforts to prevent or eliminate removal of the child(ren) from the 
 

 11. 
              home were made as determined in a prior order. 
     
              child(ren) from the home.  Those efforts include: (Specify below.) 
     
              qualified expert witness who has knowledge about the child-rearing practices of the Indian child’s tribe, that 
              active efforts 
 have not  been made to provide remedial services and rehabilitative programs 
              designed to prevent the breakup of the Indian family. These efforts have proved 
             
             
             
      The efforts for 11b or 11c are:  (Specify the efforts from 11b or 11c here. If the child is an Indian child, specify active efforts as defined  
      by MCR 3.002[1] and MCL 712B.3[a].)

the continued custody of the child(ren) by the parent or Indian custodian 
likely to result in serious emotional or physical damage to the child(ren), and the child(ren)

 should not  be removed from the home. (Specify below.)

 unsuccessful, 
 is not 
 is 
 
 
 should 

 successful, 

 have 

OR

 
 

 

 

 

 d. Reasonable efforts to prevent or eliminate removal of the child(ren) from the home were not made.
 e. Reasonable efforts to prevent or eliminate removal were not required as determined in a prior order.

     
     
 
 12.  a. Reasonable efforts are not required to prevent or eliminate the child(ren)’s removal from the home due to the
         

subjecting the child(ren) to the aggravated circumstance(s) of

 mother 

 father 

 

 

 as provided in section MCL 722.638(1) and (2), and as 

              evidenced by 
 

             

             

             

 

 

 

 

 .

 

 father’s 
 father’s 
 father’s 

 mother’s 
 mother’s 
 mother’s 

conviction for murder of another child of the parent.
conviction for voluntary manslaughter of another child of the parent.
conviction for aiding or abetting in the murder or manslaughter of 

         
         
         
              another child of the parent, attempting to murder the child(ren) or another child of the parent, or conspiring or 
              soliciting to commit the murder of the child(ren) or another child of the parent.
         
              child(ren) or another child of the parent.
         
              and failure by that parent to rectify the conditions that led to that termination.
         

conviction for felony assault that resulted in serious bodily injury to the

involuntary termination of parental rights to a sibling of the child(ren) 

  being required to register under the Sex Offender Registration Act.

 mother’s 

 mother’s 

 mother   

 father’s 

 father’s 

 father 

      b. Reasonable efforts to preserve and reunify the family to make it possible for the child(ren) to safely return home are 
 not required because the parent subjected the child or another child of the parent to one of the circumstances 
         
              stated above. 
              OR
         

 still recommended because: 

 

       (When item 12 is checked, either complete item 14 below or schedule a permanency planning hearing within 28 days of this determination.)

 
 
 
 
 
 
 
 
 
 
 
 

 
 
 

 

 

 

 

 

 
 
 
 
 
 
 
 
 
 

 
 
 
 
 

Order of Disposition (Child Protective Proceedings) 
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(12/22) 

Case No. 
 

 a. Reasonable efforts shall be made to preserve and reunify the family to make it possible for the child(ren) to 

 b. Reasonable efforts shall not be made to preserve and reunify the family because it would be detrimental to 

 13. 
              safely return home.
     
              the child(ren)’s health and safety.
     
              circumstances, reasonable efforts are now required. Those reasonable efforts have begun and include: 
              (Specify reasonable efforts, and if applicable, the reasons for return.)

 c.  Reasonable efforts to preserve and reunify the family were not previously required, but due to a change in  

             

  The child(ren) should be released to 

 .

Name(s) of parent(s), guardian, or legal custodian

 14.  Because reasonable efforts to prevent or eliminate removal or to reunite the child(ren) and family are not required, 
      a permanency planning hearing was conducted. (Use and attach form JC 19, Order After Dispositional Review/Permanency 
      Planning Hearing.)

 a. presents a substantial risk of harm to the child(ren)’s life, physical health, or mental well-being.

 No provision of service or other arrangement except removal of the child(ren) is reasonably available to 

15.  Custody of the child(ren) with the parent/guardian/legal custodian
 
 
 
 
 
 
 
 

 
         
              adequately safeguard the child(ren) from the risk of harm to the child(ren)’s life, physical health, or mental well-
              being.
         
              is/are placed are adequate to safeguard the child(ren)’s health and welfare.
 
 

 b. does not present a substantial risk of harm to the child(ren)’s life, physical health, or mental well-being.
 c.  are not relevant because the parent(s) released the child(ren) pursuant to the adoption code.

 Conditions of custody at the placement away from the home and with the individual with whom the child(ren) 

 16. 
     

 

 a. All siblings are in joint placement.
 b. All siblings are not in joint placement because:

 

              Sibling contact 

 is occurring according to law. 

 is not occurring because (see item 24 to order sibling contact):

 17.  Parenting time with 
      child(ren).
 

 
 
IT IS ORDERED:

 

 18. 

Name

      terminated.

 , even if supervised, may be harmful to the 

 is warned and the jurisdiction of the court is 

 19.  Notice is to be given to the legal/putative father(s) as required by law. 
      appear at the next hearing. 
      days.
  

 The putative father was present at the hearing and shall establish paternity within 14 

 The father was not present and must 

          

 
 
 
 
 
 

 

 

 
 

 

 
 
 

 

 

Order of Disposition (Child Protective Proceedings) 
Page 4 of 5

(12/22) 

Case No. 
 

IT IS ORDERED: (continued) 

 a. is/are placed with the department for care and supervision, and

 20.  The child(ren) is/are in the temporary custody of this court and
      
               1) the parent, guardian, or legal custodian shall execute all documents necessary to release confidential
                  information regarding the child(ren), including medical, mental, and educational reports, and shall also, 
                  within 7 days, provide the department with the name(s) and address(es) of the medical provider(s) for the 
                  child(ren). Any medical provider of the child(ren) shall release the medical records of the child(ren) to the 
                  department.
              2) if a home study has not yet been completed, then one shall be performed by the department and a copy of 
                  the home study submitted to the court not more than 30 days after the placement.
               3) upon request, the department shall release to the foster parent the information concerning the child(ren) in
                  accordance with MCL 712A.13a(18).

     

 b. remain home with or is/are released to 

 under the supervision of

Name(s) of parent(s), guardian, or legal custodian

              the department. 

 The following terms and conditions apply to the parent(s)/guardian/legal custodian:

 c.  because the parent(s) released the child(ren) pursuant to the adoption code, the child(ren) is/are

 committed to the department for permanency planning, supervision, care, and placement under 

      
             
                  MCL 400.203.
             

 other:

              A posttermination review hearing will be held 

Date

 . 

 21.  While the child(ren) is/are placed out of the home, the friend of the court must take the necessary steps to appropriately 
      assign or redirect child support pursuant to law.

 22.  The director of the department is appointed special guardian to receive any benefits now due or to become due the
      child(ren) from the government of the United States.

 23. The adjudicated respondent(s) 
 
      shall comply with, and benefit from, the case service plan. 
     

 In addition,

 24.  Sibling contact shall be as follows:

 25. 
             
             
   
     
             
             

 a.  Parenting time of 
 unsupervised. 
 The department has discretion to allow unsupervised or supervised parenting time by its designee.

 supervised until further order of the court.

 

 b.  Parenting time of 
 
 unsupervised. 
 The department has discretion to allow unsupervised or supervised parenting time by its designee.

 supervised until further order of the court.

 is 

 is

 
 
 
 
 
 
 
 
 
 

 

 

 
 
 
 

 

 

 

 
 

 

 
 
 
 
 
 

Order of Disposition (Child Protective Proceedings) 
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(12/22) 

Case No. 
 

     
             
             

 c.  Parenting time of 
 unsupervised. 
 The department has discretion to allow unsupervised or supervised parenting time by its designee.

 supervised until further order of the court.

 

 

 is 

IT IS ORDERED:  (continued)

 
 
 

 

     

 d. 

 26.  Reimbursement:

 27.  Other: (Attach separate sheet if needed.) (An order for child support must comply with MCR 3.973[F][5] and MCR 3.211.)

 28. Prior orders remain in effect except as modified by this order.

 29.  Review hearings shall be held as follows:
       (Note: The review hearing shall not be delayed beyond the number of days required regardless whether a petition to terminate parental rights or 
      another matter is pending. MCL 712A.19a provides that the permanency planning hearing shall not be delayed beyond 12 months from the date
       of removal of the child and every 12 months thereafter.) 
     
      The supervising agency shall provide documentation of  progress relating to all aspects of the last court-ordered 
      treatment plan, including copies of evaluations and therapy reports and verification of parenting time, no less 
      than 7 days before the scheduled hearing.

 permanency planning hearing 

 dispositional review hearing 

 dispositional review hearing 

 

 

 

 

 

 

 

 
 
 
 
 
 

 30. 

 Notice of the next hearing has been provided as required by law. 

 

 Notice of the next hearing shall be provided.

 

                     

Recommended by:

Referee signature and date

 

                     

Judge signature and date