Full Name:

Opposing Party Name:

Current Address:

Opposing Party's Address:

Children's names and ages:

Is there already a case on file? If so, what county is the case filed in and what is the case number?

If you and the opposing party are separated, please describe the parenting time each of you are currently exercising with your children:

What is your ideal parenting schedule?

Are you requesting joint or sole custody? If you are requesting sole custody, please describe in detail the reasons for your request:

Are you making any allegations of child abuse or neglect against the opposing party and/or has the opposing party made any allegations of child abuse or neglect against you? If yes, please describe in detail including any involvement with the police or Children’s Division:

Do you or the opposing party have any current or past issues with substance abuse? If yes, please describe:

Do you or the opposing party have any current or past mental health diagnosis and/or are either of you currently undergoing treatment for any mental health issues? If yes, please describe:

Are you requesting child support from the opposing party?

What is your average gross monthly income?

What is the opposing party’s average gross monthly income?

Who covers health insurance for your child(ren)?

Do you have any childcare costs for your child(ren)? Who covers these costs?

Do you have any other children not of this relationship? If so, please list their ages, whether they live with you or their other parent primarily, and whether you receive or pay child support for each child:

Please add anything else you believe I should know about your case: