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Guardian ad Litem Child/Ward Questionnaire

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Submitted on Aug 25, 2026 at 1:20 AM

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Guardian ad Litem Child/Ward Questionnaire

Instructions
This questionnaire is part of a court-related Guardian ad Litem Investigation. Complete it personally, thoroughly, and truthfully. Do not allow another person to answer on your behalf. Attach additional pages when necessary and clearly label each attachment by section number.

Because a separate Parent History Questionnaire will be completed, this form focuses specifically on the child’s experiences, development, emotional and behavioral functioning, family relationships, safety concerns, adjustment, and needs. This questionnaire also includes limited questions regarding the child’s exposure to family conflict, caregiving arrangements, and issues relevant to the Guardian ad Litem Investigation.

Complete one form for each child involved in this Guardian ad Litem Investigation.

Participant Initials^*

Date^*

I understand and agree^*

I have answered these questions truthfully and to the best of my ability.

I will supplement my answers if I later learn information is incomplete or inaccurate.

I understand that false, incomplete, or misleading answers may be considered by the evaluator and the Court.

I understand the evaluator may compare my answers with records, interviews, collateral information, and other evidence.

Section 1 - Child Information

Child Full Name^*

Date of Birth^*

Current Age^*

Current Grade^*

Current School^*

Person Completing Questionnaire^*

Relationship to Child^*

Current Living Arrangement^*

Section 2 - Child Overview and Functioning

Rate Emotional Functioning^*

Excellent

Good

Fair

Poor

Explain Emotional Functioning^*

Rate Behavioral Functioning^*

Excellent

Good

Fair

Poor

Explain Behavioral Functioning^*

Rate Academic Functioning^*

Excellent

Good

Fair

Poor

Explain Academic Functioning^*

Rate Social Functioning^*

Excellent

Good

Fair

Poor

Explain Social Functioning^*

Rate Adaptability to Change^*

Excellent

Good

Fair

Poor

Explain Adaptability to Change^*

Describe this child's greatest strengths^*

Describe this child's greatest challenges^*

Describe three things that make this child unique^*

Section 3 - Important Relationships Matrix

Relationship with Mother^*

Relationship with Father^*

Relationship with Siblings^*

Relationship with Stepparents/Partners^*

Relationship with Grandparents^*

Relationship with Extended Family^*

Relationship with Other Important Adults^*

Section 4 - School Functioning

School history and attendance^*

Academic performance^*

Behavioral concerns^*

IEP/504/Gifted services^*

Tutoring or academic supports^*

Educational strengths and weaknesses^*

Section 5 - Medical and Mental Health History

Primary physician^*

Medical diagnoses^*

Mental health diagnoses^*

Current medications^*

Hospitalizations^*

Surgeries^*

Head injuries^*

Current providers^*

Counseling history^*

Psychological evaluations^*

Psychiatric treatment history^*

Section 6 - Developmental History

Pregnancy complications^*

Birth complications^*

Prematurity/NICU stay^*

Speech delays^*

Language delays^*

Learning disabilities^*

ADHD concerns^*

Autism concerns^*

Other developmental concerns^*

Section 7 - Adjustment to Separation, or Other Significant Family Changes

Initial response to separation/divorce^*

Current adjustment^*

Changes in mood, behavior, sleep, appetite, school performance, friendships, and activities^*

Section 8 - Exposure to Family Conflict

Exposure to family conflict^*

Exposure to exchanges^*

Exposure to police involvement^*

Exposure to DCF/CPS involvement^*

Exposure to court hearings or litigation discussions^*

Section 9 - Child Exposure to Adult Issues

Steps taken to protect the child/ward from conflict^*

Exposure to court documents^*

Exposure to emails/texts^*

Asked to relay messages^*

Asked to keep secrets^*

Asked to choose between caregivers or participants^*

Exposure to allegations^*

Exposure to recordings, videos, or social media regarding the case^*

Section 10 - Child Statements, Preferences, and Concerns

Positive comments child has made about Mother/Participant 1^*

Positive comments child has made about Father/Participant 2^*

Concerns child has expressed regarding Mother/Participant 1^*

Concerns child has expressed regarding Father/Participant 2^*

Concerns child has expressed about the family situation^*

Provide examples and context^*

Section 11 - Behavioral and Safety Concerns

School discipline^*

Suspensions/expulsions^*

Running away^*

Self-harm concerns^*

Threats to others^*

Property destruction^*

Substance use^*

Law enforcement involvement^*

DCF involvement^*

Participant Initials^*

Date^*

SECTION 12 – CHILD STRENGTHS AND PROTECTIVE FACTORS

Who does the child turn to for support?^*

Activities that build confidence^*

Protective adults in the child's life^*

Strengths that help the child cope with stress^*

Community, school, religious, or extracurricular supports^*

Participant Initials^*

Date^*

SECTION 13 - CHILD'S FUTURE NEEDS

What does this child need most right now?

What services would benefit this child?

What care arrangement would best support this child's needs?

Participant Initials^*

Date^*

SECTION 14 - CHILD TIMELINE

Parents separated

School changes

Counseling started

Medical diagnoses

DCF investigations

Major relocations

Significant losses or life events

Participant Initials^*

Date^*

SECTION 15 - DOCUMENT PRODUCTION CHECKLIST

Report cards

Attendance records

Discipline records

IEP/504 plans

Psychological evaluations

Therapy records

Psychiatric records

Medical records

Participant Initials^*

Date^*

DCF records

Police reports

Extracurricular records

Awards/certificates

Other relevant records

Participant Initials^*

Date^*

SECTION 16 - ADDITIONAL INFORMATION

What additional information should the GAL know about this child/ward?

Participant Initials^*

Date^*

Section 17: Child Electronic Device Questions

Does the child have a phone?^*

Yes

Does the child have a tablet?^*

Yes

Does the child have a smart watch?^*

Yes

Does the child have social media accounts?^*

Yes

Who pays for the device?^*

Who controls the device?^*

Are parental controls used?^*

Is communication with the other parent monitored?^*

Participant Initials^*

Date^*

Section 18: Child's Favorite Things

Favorite activities^*

Best friend^*

Future career interests^*

Favorite games^*

Favorite YouTube channels^*

Favorite subjects^*

Participant Initials^*

Date^*

SECTION 19: FUNCTIONAL ABILITIES (ADULTS ONLY)

Explanation (if needs supervision is selected)^*

Participant Initials^*

Date^*

VERIFICATION AND CERTIFICATION

I certify that I personally completed this questionnaire and that the information provided is true and accurate to the best of my knowledge and belief.

Printed Name^*

Signature^*

Sign here

Date^*

Page Initials Confirmed^*

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