Dispute Resolution DEPARTMENT

REQUEST FOR SERVICES

Case Name	Date

Case No	File No.

Pre-Decree	Agreed Referral	Full Investigation

Post-Decree	Post Decree Mediation	Brief Focused Investigation

Court Ordered (by Judge/Mag)	Other

(State reason below)

Mother has filed for	Shared parenting To be sole residential parent Change of Parenting time

Other

Father has filed for	Shared Parenting To be sole residential parent Change of Parenting time

Other

Specific problems to be addressed:

Mother:

Name

Address City State

Home Phone Zip

Employer Work Phone

Attorney Phone No

Father:

Name

Address City State

Home Phone Zip

Employer

Work Phone

Attorney Phone No

Children:

Name	Age	Living With Whom

Age	Living With Whom

Age	Living With Whom

Age	Living With Whom

To Be Completed by Court Parenting Investigations

Follow up hearing to be set? Yes No	Length of time for hearing

Before Judge/Magistrate Date of hearing (if pre-set by Magistrate or Judge – please call Dispute Resolution Dept. to obtain approx. time frame for appt. date – hearings should occur no sooner than 45 days after first scheduled appt. with the parents)

DR 2.4 (Revised 11/24/2015)