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Guardian ad Litem Questionnaire

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Submitted on Aug 24, 2026 at 10:52 PM

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Guardian ad Litem 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.

This questionnaire focuses on the participant, household or living environment, caregiving history, safety issues, litigation issues, and proposed care plan or recommendations.

This questionnaire is intended for use in Guardian ad Litem appointments involving minor children, vulnerable adults, alleged incapacitated persons, protected persons, or other individuals who are the subject of the Court’s Order of Appointment, collectively referred to as the “Ward.”

For ease of reading, terms such as “child,” “ward,” “protected person,” “participant,” “parent,” “caregiver,” or similar terms may be used throughout this questionnaire. Unless the context clearly indicates otherwise, these terms should be interpreted as referring to the individual or role applicable to your case. The use of one term instead of another is intended only to improve readability and does not limit or change the applicability of any question or instruction.

If a question does not apply to your circumstances, write “N/A.”

Please note: This questionnaire is intended to assist the Guardian ad Litem in gathering background information. Completing this questionnaire does not replace interviews, collateral contacts, record reviews, observations, or other investigative activities conducted during the Guardian ad Litem investigation.

SECTION 1 - CASE INFORMATION

Who requested the Guardian ad Litem appointment?*
What issues are currently in dispute? (check all that apply)*
Current relationship status:*

SECTION 3 – CHILDREN/WARD INVOLVED IN THIS GUARDIAN AD LITEM APPOINTMENT

Child/Ward basic identifying information*

SECTION 4 - RELATIONSHIP AND SEPARATION HISTORY (with coparticipant)

Relationship and separation history (with coparticipant)*

SECTION 5 - RESIDENTIAL HISTORY

A. Residences Shared with the Other Participant

Residences shared with the other participant*

B. Residences Separate from the Other Participant After Separation

Residences after separation (separate residences)*
Do you anticipate moving within the next 6 months, 1 year, or 5 years?*
Do you believe the other participant anticipates moving within the next 6 months, 1 year, or 5 years?*

SECTION 6 - CURRENT LIVING ARRANGEMENTS AND SIGNIFICANT RELATIONSHIPS

A. Current Household Members

Current household members*

B. Current Partner/New Spouse

Current partner/new spouse*
Current partner/new spouse involvement with the child(ren):*
Has any child expressed concerns about your current partner/new spouse?*
Has your current partner/new spouse been involved in any conflict with the other participant?*

C. Current Partner/New Spouse Children

Current partner/new spouse children*
Have there been conflicts between your child(ren) and your partner/new spouse's children?*
Yes / No / Unsure/Unknown*

SECTION 7 - CAREGIVING HISTORY AND RESPONSIBILITIES

A. Caregiving Responsibilities Before Separation

Caregiving responsibilities before separation*

B. Caregiving Responsibilities Since Separation

Caregiving responsibilities since separation*

SECTION 8 - CURRENT COURT ORDERED ARRANGEMENT

How was the current arrangement created?*
Have there been missed visits, denied visits, late exchanges, or recurring schedule disputes?*
Are there safety concerns during exchanges?*

SECTION 9 - COMMUNICATION AND DECISION-MAKING

How do you and the other participant communicate? (check all that apply)*
Topic conflicts (rating and explanation)*

SECTION 10 - ALLEGATIONS AND CURRENT CONCERNS

Check any concerns you have about the other participant:*
Allegations / incidents (details for checked concerns)*

SECTION 11 - PARTICIPANT-WARD RELATIONSHIP, GATEKEEPING, AND UNDUE INFLUENCE CONCERNS

Since separation, has this child:*
Since separation, have you or anyone in your household:*
Gatekeeping / contact restrictions (check all that apply):*

SECTION 12 - CONFLICT EXPOSURE

Has any child been exposed to:*

SECTION 13 - DOMESTIC VIOLENCE, COERCIVE CONTROL, AND SAFETY SCREENING

Has either participant ever engaged in or experienced:*
Incident / Concern details*
Is there an active injunction, no-contact order, or safety plan?*
Do you currently fear the other participant or anyone in the other participant's household?*
Do you believe the child(ren) fear either the participant or the household?*

SECTION 14 - DCF/CPS, PROTECTIVE SERVICES, LAW ENFORCEMENT, AND PRIOR INVESTIGATIONS

Agency / investigation records*
Has the ward ever been interviewed by DCF/CPS, law enforcement, Child Advocacy Center, GAL, therapist, evaluator, or another professional regarding allegations or safety concerns?*
Have there been prior Guardian ad Litem appointments, custody evaluations, psychological evaluations, substance evaluations, or caregiving assessments?*

SECTION 15 - MENTAL HEALTH HISTORY

Have you ever experienced or been diagnosed with:*
Provider / treatment history*
Are you currently in counseling, therapy, psychiatric care, coaching, or other mental health treatment?*
Has any mental health condition ever affected your caregiving, judgment, employment, or relationships?*

SECTION 16 - SUBSTANCE USE HISTORY

Current or past use:*
Substance use history*
Have you ever had a DUI, substance-related arrest, failed drug test, or substance-related employment issue?*
Has anyone alleged that your substance use affects your caregiving?*
Do you have concerns about the other participant's substance use?*

SECTION 17 - FAMILY OF ORIGIN AND DEVELOPMENTAL HISTORY

Who primarily raised you during childhood?*
Did you experience any of the following while growing up?*
Mother / Participant 1*
Father / Participant 2*
Siblings*
Family issue history (who, treatment/response, status, relevance)*

SECTION 18 - EDUCATION, EMPLOYMENT, AND FINANCIAL STABILITY

Education / school history*
Employment history*
Do you anticipate job changes, schedule changes, unemployment, or relocation?*
Are there financial issues that affect housing, transportation, childcare, medical care, or activities?*
Has the child ever stayed overnight with this caregiver?*

SECTION 19 - LEGAL HISTORY

Legal issues / matters*
Has your driver's license ever been suspended, canceled, or revoked?*

SECTION 20 - EXTENDED FAMILY, SUPPORTS, CHILDCARE, AND COMMUNITY

Extended family, supports, childcare, and community*

SECTION 21 - SOCIAL MEDIA, TECHNOLOGY, AND RECORDINGS

Have you or anyone in your household: (check all that apply)*
Social media accounts (platform, username, active?)*

SECTION 22 - PROPOSED COURT ORDERS

Decision-making requested: (check all that apply)*

SECTION 23 - SELF-ASSESSMENT AND INSIGHT

SECTION 24 - COLLATERAL WITNESSES

Collateral witnesses (name, relationship, phone, email, firsthand knowledge, observed)*

SECTION 25 - DOCUMENT PRODUCTION CHECKLIST

Court and litigation records*
Ward-related records*
Safety and agency records*
Communication and digital records*
Household and practical records*

SECTION 26 - ADDITIONAL INFORMATION

VERIFICATION AND CERTIFICATION

Assistance received
I understand and agree (check all that apply)
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