Name - Judge
[TM1] / Hearing Date (mm/dd/yyyy)
[TM2][TM3] / eWiSACWIS Case Number
[TM4]
Court Number
[TM5] / County
[TM6] / Case Type
CHIPS
Child
Name (Last, First, MI)
[TM7] / Birthdate
[TM8] / Age
[TM9]
Address (Street, City, State, Zip Code)
[TM10] / Telephone Number
[TM11]
Tribal Information
[TM12] Yes [TM13] No / Is the child an American Indian?
If Yes, name of American Indian Tribe or Band: [TM14]
[TM15] Yes [TM16]No / If the above child is American Indian, has the Tribehave the Tribes[TM17] been notified of these proceedings?
Verification of American Indian status provided by: [TM18]
Current Caregiver
Name - Caregiver 1 (Last, First, MI)
[TM19] / Name - Caregiver 2 (Last, First, MI)
[TM20] / Relationship to Child
[TM21]
Address (Street, City, State, Zip Code)
[TM22] / Telephone Number
[TM23]
Mother / [TM24] Unknown / [TM25] Deceased
Name (Last, First, MI) Status: [TM26] Birth [TM27] Adoptive / Birthdate
[TM28] / [TM29]
Address (Street, City, State, Zip Code)
[TM30] / Telephone Number
[TM31]
Marital Status / Name - Spouse
[TM32] Married [TM33] Single [TM34] Widowed [TM35] Divorced / [TM36]
Father / [TM37]Unknown / [TM38] Deceased
Name (Last, First, MI) / Birthdate
[TM39] / [TM40]
Address (Street, City, State, Zip Code)
[TM41] / Telephone Number
[TM42]
Marital Status / Name - Spouse
[TM43] Married [TM44] Single [TM45] Widowed [TM46] Divorced / [TM47]
Status: [TM48] Adjudicated [TM49] Adoptive [TM50] Alleged [TM51] Presumptive
In the interest of, [TM52], a child under the age of 18 years, on this child was found to be in need of protection or services pursuant to Wisconsin Statutes s. 48.13 ( [TM53]), [TM54] and the court order expires on [TM55].
I.Social History of Child
[TM56]
II.Statement of Facts Supporting the Need for Termination[TM57]
III.Agency Action, Services to the Family, and Their Response[TM58]
IV.Services Which Could, if Utilized, Allow the Child to Return to the Parent[TM59]
V.Standards and Factors Under Wisconsin Statute s. 48.426(2) and (3)[TM60]
VI.Recommendation and Future Plan[TM61]
VII.Signatures[TM62]
Name - Worker
SIGNATURE - Worker / Date Signed
[TM63]
Name - Supervisor
SIGNATURE - Supervisor / Date Signed
Court Report for Termination of Parental Rights / Page 1 of 2
CFS-2117 (Rev. 12/2004)
[TM1]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Judge field on the Legal Documentation page.
[TM2]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM3]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM4]This field is pre-filled. This field is not editable on the template. The data cannot be corrected.
[TM5]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM6]This field is pre-filled. This field is not editable on the template. The data cannot be corrected.
[TM7]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: if an incorrect child was selected, the information can be updated by selecting the ‘Child’ role for the correct child in the Role in Document group box on the Legal Documentation page. If the child name is misspelled, the data can be updated on the Basic tab of the Person Management page.
[TM8]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: updated the Basic tab of the child's Person Management page.
[TM9]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: updated the Basic tab of the child's Person Management page.
[TM10]This field is pre-filled. This field is not editable on the template. The data cannot be corrected, as it pre-fills from the primary address (which is the address of the Out of Home Placement's provider).
[TM11]This field is pre-filled. This field is not editable on the template. The data cannot be corrected, as it pre-fills from the primary address (which is the address of the Out of Home Placement's provider).
[TM12]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Ethnicity field on the Basic tab of the Person Management page.
[TM13]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Ethnicity field on the Basic tab of the Person Management page.
[TM14]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Indian Tribe field on the Basic tab of the Person Management page.
[TM15]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM16]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM17]This field is user selectable. This field is editable on the template. The data can be corrected on the template. The values are: [has the Tribe] [have the Tribes]
[TM18]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM19]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Members tab of the Home Provider page for the provider on the child's Out of Home Placement.
[TM20]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Members tab of the Home Provider page for the provider on the child's Out of Home Placement.
[TM21]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM22]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the address of the provider on the child's Out of Home Placement.
[TM23]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the address of the provider on the child's Out of Home Placement.
[TM24]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM25]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM26]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM27]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM28]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Person Management page for the child's mother. The child's mother is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM29]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Person Management page for the child's mother. The child's mother is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM30]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the Person Management page for the child's mother. The child's mother is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM31]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the Person Management page for the child's mother. The child's mother is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM32]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM33]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM34]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM35]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM36]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM37]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM38]This field is user selected. This field is editable on the template. The data can be corrected on the template.
[TM39]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Person Management page for the child's father. The child's father is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM40]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Person Management page for the child's father. The child's father is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM41]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the Person Management page for the child's father. The child's father is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM42]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Address tab of the Person Management page for the child's father. The child's father is identified on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM43]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM44]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM45]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM46]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM47]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM48]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Type field on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM49]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Type field on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM50]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Type field on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM51]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: update the Type field on the Parent Info tab of the child's Person Management page. The child is identified by the role of "Child" in the Role in the Document on the Legal Documentation page.
[TM52]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows:
[TM53]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM54]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM55]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM56]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM57]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM58]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM59]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM60]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM61]This field is user entered. This field is editable on the template. The data can be corrected on the template.
[TM62]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: the worker's name can be updated by a supervisor on the worker's Person Management page.
[TM63]This field is pre-filled. This field is not editable on the template. The data can be corrected as follows: the supervisor's name can be updated by a supervisor on the supervisor's Person Management page.