City, State, Zip 

 
Name 

 
Address 

 
Phone 

 
Email 

 

 
 
 
 
 
 
 
Check your email. You will receive information and 
documents at this email address.  

I am   [  ]  Petitioner 

[  ]  Respondent 
[  ]  Respondent’s Attorney                     (Utah Bar #:__________) 

[  ]  Petitioner’s Attorney 
[  ]  Petitioner’s Licensed Paralegal Practitioner 
[  ]  Respondent’s Licensed Paralegal Practitioner   

(Utah Bar #:__________) 

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of (select one) 
 

[  ]  the Marriage of (for a divorce with or 
without children, annulment, separate 
maintenance, or temporary separation case) 

[  ]  the Children of (to establish custody, 

parent-time or child support) 

[  ]  the Parentage of the Children of (for a 

paternity case) 

____________________________________ 
(name of Petitioner) 

and  

 

____________________________________ 
(name of Respondent) 
____________________________________________ 
Other parties (if any) 

Motion to Appoint a Parent 
Coordinator 
(Code of Judicial Administration Rule 4-509) 

_______________________________ 
Case Number 

_______________________________ 
Judge 

_______________________________ 
Commissioner 

1.  This case involves a dispute about child custody or parent-time. I ask the court to 

appoint a parent coordinator because: 

1221FAJ Approved August 17, 2018 / 
Revised May 1, 2022 

Motion to Appoint a Parent Coordinator 

Page 1 of 5 

 

I ask the court appoint one of the following as a parent coordinator:  
(Print the name of any qualified professionals listed you are willing to have appointed as parent 
coordinator. The requirements can be found in Utah Code of Judicial Administration Rule 4-
509(4).) 

I have attached a Parent Coordinator Qualification Statement for each 
professional as listed in paragraph 2. 

I understand the law requires the parents to meet with the parent coordinator for 
at least 4 hours unless a parenting plan is finalized sooner. I believe (Choose one.): 

[  ]  4 hours is sufficient time. 

[  ]  _____ additional hours would be required because 

5. 

Petitioner should pay _____ % of the parent coordinator’s fee and respondent 
should pay _____ % because: 

6. 

(Choose one.) 

[  ]    The parent coordinator will perform the services listed in Utah Code of 

Judicial Administration Rule 4-509. 

[  ]    The parent coordinator will do only the following: 

1221FAJ Approved August 17, 2018 / 
Revised May 1, 2022 

Motion to Appoint a Parent Coordinator 

Page 2 of 5 

       

   

   

   

 

2. 

3. 

4. 

 

laintiff/Petitioner or Defendant/Respondent  

I declare under criminal penalty under the law of Utah that everything stated in this document is true. 

Signed at ______________________________________________________ (city, and state or country). 

ttorney or Licensed Paralegal Practitioner of record (if applicable) 

Signature ► 

Printed Name 

Signature ► 

Printed Name 

 

 

 

 

1221FAJ Approved August 17, 2018 / 
Revised May 1, 2022 

Motion to Appoint a Parent Coordinator 

Page 3 of 5 

     

  P

    A

 

 
Date 

 
Date 

 

Aviso para la parte que responde 
Su tiempo para responder a esta moción es 
limitado. En la mayoría de casos deberá 
presentar una respuesta escrita con el tribunal 
y darle una copia de la misma a la otra parte: 
• dentro de 14 días del día que se presenta 
la moción, si la misma será resuelta por un 
juez, o 

• por lo menos 14 días antes de la 

audiencia, si la misma será resuelta por un 
comisionado.  

n algunos casos debido a un estatuto o a una 

orden de un juez la fecha límite podrá ser 
distinta.  
  
Si usted no responde a esta moción ni se 
presenta a la audiencia, la persona que 
presentó la moción podría recibir lo que pidió.  
  
Vea la página del tribunal sobre Mociones para 
encontrar más 
información sobre el 
proceso de las mociones, 
las fechas límites y los 
formularios:  
utcourts.gov/motions-span 

Para accesar esta página 
escanee el código QR 

Para accesar esta página 
escanee el código QR 

Cómo encontrar ayuda 
legal 
La página de la internet 
del tribunal Cómo 
encontrar ayuda legal 
(utcourts.gov/help-
span)  
tiene información sobre algunas maneras de 
encontrar ayuda legal, incluyendo el Centro de 
Ayuda de los Tribunales de Utah, abogados 
que ofrecen descuentos u ofrecen ayuda legal 
limitada, y talleres legales gratuitos. 

  E

otice to responding party 

You have a limited amount of time to 
respond to this motion. In most cases, 
you must file a written response with 
the court and provide a copy to the 
other party: 

• within 14 days of this motion being 
filed, if the motion will be decided 
by a judge, or 

• at least 14 days before the 

hearing, if the motion will be 
decided by a commissioner. 

n some situations a statute or court 
order may specify a different deadline.  

f you do not respond to this motion or 
attend the hearing, the person who 
filed the motion may get what they 
requested.  

ee the court’s 

Motions page for more 
information about the 
motions process, 
deadlines and forms: 
utcourts.gov/motions 

Scan QR code  
to visit page 

Finding help 
The court’s Finding 
Legal Help web page 
(utcourts.gov/help) 
provides information 
about the ways you 
can get legal help, including the Self-
Help Center, reduced-fee attorneys, 
limited legal help and free legal clinics.  

Scan QR code  
to visit page 

1221FAJ Approved August 17, 2018 / 
Revised May 1, 2022 

Motion to Appoint a Parent Coordinator 

Page 4 of 5 

  N

  I

  I

  S

 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Motion to Appoint a Parent Coordinator on 
the following people. 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

 

 

 

 

 

 

 
Date 

Signature ► 

Printed Name 

 

 

1221FAJ Approved August 17, 2018 / 
Revised May 1, 2022 

Motion to Appoint a Parent Coordinator 

Page 5 of 5