STATUS CONFERENCE WORKSHEET 

Assets and Debts 

Cash Assets and Investments: 
  
  
  
  
  

Personal Property: 
  
  
  
  

Vehicles: 
  
  
  
  
  

 

   

       

Real Property: 
  
  
  
  
  

Retirements: 
  
  
  
  
  

Debt Allocation: 
  
  
  
  
  

  

 

 

  
  
  
  
  
  
  
  

  
  
  
  
  
  
  

  
  
  
  
  

  

  

Alimony 

Attorney Fees 

Maiden Name 

  

 

Custody 

Legal – Sole / Joint 

 

Petitioner: 
  
  
  
  
  

Respondent: 
  
  
  
  
  

Primary residence: 
  
  
  
  
  

Physical – Sole / Joint ( # of overnights to Petitioner _____ / Respondent _____ ) 

Routine schedule: 
  
  
  
  
  

Holidays (30-3-35): 
  
  
  
  
  

Extended Time (30-3-35.1): 
  
  
  
  
  

Transportation and Exchanges: 
  
  
  
  
  

 

 

Child-Related Expenses 

Child Support – Sole / Joint ( # of overnights to Petitioner _____ / Respondent _____ ) 

Gross Monthly Income: 

  

  

  
  
  
  
  

Arrearages (payment plan): 
  
  
  
  
  

Health Costs: 

❏

  Health Insurance: 

❏

  Premium Cost $ __________ 

o   Primary __________ 
o   Secondary ________ 
  

❏

  Uninsured Health-Related Costs: 

Parenting Plan 

Advisory Guidelines (30-3-33) 
Relocation (30-3-37) 

Other Costs (extracurricular activities, school fees, etc.): 
  
  
  
  
  

 

   

Communication between parents (phone, email, text, etc.): 
  
  
  
  
  

Childcare Costs: 
  
  
  
  
  

Exchange of contact information: 
  
  
  
  
  

Communication between parent and child (phone, virtual, email, times, etc.): 
  
  
  
  
  

Surrogate care (family, daycare, etc.): 
  
  
  
  
  

School: 
  
  
  
  
  

Travel with child(ren) (notice, where, when, who, contact info): 
  
  
  
  
  

Mutual restraints (derogatory, disparaging, children as messengers, civil communications, 
substance abuse, etc.): 
  
  
  
  
  

 

 

Tax Exemption 

Modification 

  

  
  
  
  
  
  
  
  

  

 

Issues: