APPELLATE ASSIGNMENT INTAKE Case (Child) Name: ______________________________________________________ Trial Court & Judge: Docket: ___________________ Disposition (circle): Permanent Custody/ Termination/ Guardianship/ Private Adoption/ Other Client’s Name & Contact Information: ________________________________________ ________________________________________________________________________ Names and dates of birth of Relationship Trial Attorney all parties (Mother/Father/ Number) Children/Other) Department of Children & Same Families Note: Please specify if children are represented by separate counsel, or if there is more than one mother or father involved or represented in the case. Please indicate which party(ies) filed a notice of appeal: Mother Father Child(ren) _____ Guardian Other: __________________________ Date notice of appeal filed: _______
APPELLATE ASSIGNMENT INTAKE Case (Child) Name: ______________________________________________________ Trial Court & Judge: Docket: ___________________ Disposition (circle): Permanent Custody/ Termination/ Guardianship/ Private Adoption/ Other Client’s Name & Contact Information: ________________________________________ ________________________________________________________________________ Names and dates of birth of all parties Relationship (Mother/Father/ Children/Other) Trial Attorney Number) Department of Children & Families Same Note: Please specify if children are represented by separate counsel, or if there is more than one mother or father involved or represented in the case. Please indicate which party(ies) filed a notice of appeal: Mother Father Child(ren) _____ Guardian Other: __________________________ Date notice of appeal filed: _______