Guardian ad Litem Collateral Witness Questionnaire

Instructions

This questionnaire is intended to gather information from collateral witnesses with knowledge of the child and family. Provide information based on personal observation whenever possible. This questionnaire is not confidential and may be disclosed to the Court, attorneys, parties, and other professionals involved in this matter. Please type your responses. Attach additional pages if necessary.

Case Name^*

Case Number^*

Child(ren)^*

Parent/Participant Who Identified You^*

Date Completed^*

Investigation Type^*

GAL

Social Investigation

Parenting Evaluation

FMHE

Reunification

Parenting Coordination

Other

SECTION 2 – WITNESS INFORMATION

Full Name^*

Address^*

Country

Street address

Apartment, suite, etc.

Phone^*

Email^*

Educational Background^*

Occupation^*

Employer^*

Marital Status^*

Number of Children^*

Collateral Type (check all that apply)^*

Family Member

Friend

Neighbor

Teacher

Coach

Therapist

Medical Provider

Employer

Other

SECTION 3 – RELATIONSHIP TO THE FAMILY

Contact Frequency with Family Members^*

How long have you known the Mother?^*

How long have you known the Father?^*

How long have you known the Child(ren)?^*

When was the last time you saw the child/ward?^*

SECTION 4 – SOURCE OF INFORMATION

My information is based upon^*

Personal Observation

Information from Mother

Information from Father

Information from Child

Information from Another Person

Approximate percentage based on firsthand observation^*

Approximate percentage based on information from others^*

Identify any important information that you did NOT personally observe^*

Have you reviewed or been informed about any of the following before completing this questionnaire?^*

Court documents

Social media posts

Emails

Text messages

Reports

Information provided by Mother

Information provided by Father

If yes, provide details^*

SECTION 5 – OBSERVATIONS OF THE CHILD

Child Observations^*

Please provide specific examples you have personally observed^*

SECTION 6 – OBSERVATIONS OF MOTHER

Mother Observations^*

Describe specific strengths of the Mother you personally observed^*

Describe specific concerns of the Mother you personally observed^*

SECTION 7 – OBSERVATIONS OF FATHER

Father Observations^*

Describe specific strengths of the Father you personally observed^*

Describe specific concerns of the Father you personally observed^*

SECTION 8 – INTERFERENCE / GATEKEEPING OBSERVATIONS

Interference / Gatekeeping Observations^*

Provide specific examples^*

SECTION 9 – SIGNIFICANT EVENTS OR INCIDENTS

Significant Events or Incidents^*

SECTION 10 – ADDITIONAL INFORMATION

Is there anything else the evaluator should know?^*

CERTIFICATION

I understand that this questionnaire may be reviewed by the Court, attorneys, parties, and professionals involved in this matter. I certify that my responses are true and accurate to the best of my knowledge.

Printed Name^*

Signature^*

Sign here

Date^*

ACKNOWLEDGMENT

STATE OF^*

COUNTY OF^*

Acknowledged on this day of^*

Acknowledged by^*

Who is^*

Personally known to me

Produced identification

Type of Identification Produced^*

Witness/Collateral Informant Signature^*

Sign here

Printed Name^*

NOTARY PUBLIC

Signature of Notary Public^*

Sign here

Printed Name of Notary^*

Commission Number^*

My Commission Expires^*

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Guardian ad Litem Collateral Witness Questionnaire

SECTION 2 – WITNESS INFORMATION

SECTION 3 – RELATIONSHIP TO THE FAMILY

SECTION 4 – SOURCE OF INFORMATION

SECTION 5 – OBSERVATIONS OF THE CHILD

SECTION 6 – OBSERVATIONS OF MOTHER

SECTION 7 – OBSERVATIONS OF FATHER

SECTION 8 – INTERFERENCE / GATEKEEPING OBSERVATIONS

SECTION 9 – SIGNIFICANT EVENTS OR INCIDENTS

SECTION 10 – ADDITIONAL INFORMATION

CERTIFICATION

ACKNOWLEDGMENT

NOTARY PUBLIC