Full Name:

Current Address:

Name and age of each child for whom you are requesting guardianship:

Where do the child(ren) currently reside? If they reside with you, how long have they resided with you?

Your relationship to the child(ren) you are requesting guardianship of:

Name and current place of residence of each child’s biological parents:

Are the child(ren)’s biological parents in agreement with you being appointed as guardian?

Do you have a social security number? (This is needed for purposes of running a background check):

Are you presently employed? If so, where?

Are you currently married?

Please describe the reasons you are requesting guardianship, including anything that makes the child(ren)’s biological parents unable to care for them:

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