PSB Pro Bono GAL Request Form
This form is only for use by Judges, J.A.'s, and Court Staff.
Case #
*
Type
*
Family Court GAL (39)
Human Trafficking GAL (49)
Domestic Violence GAL
Other
Judge:
*
Contact name for more info
*
Contact #:
*
Next Hearing Date:
*
/
Month
/
Day
Year
Date
Hearing Time:
*
Type of hearing:
*
Language required
*
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Child/ren
Child 1 Name
*
First Name
Last Name
D.O.B.
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Race
*
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
Child 2 Name
First Name
Last Name
D.O.B.
-
Month
-
Day
Year
Date
Gender
Male
Female
Race
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
Child 3 Name
First Name
Last Name
D.O.B.
-
Month
-
Day
Year
Date
Gender
Male
Female
Race
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
Child 4 Name
First Name
Last Name
D.O.B.
-
Month
-
Day
Year
Date
Gender
Male
Female
Race
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
Child 5 Name
First Name
Last Name
D.O.B.
-
Month
-
Day
Year
Date
Gender
Male
Female
Race
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
Child 6 Name
First Name
Last Name
D.O.B.
-
Month
-
Day
Year
Date
Gender
Male
Female
Race
Asian or Pacific Islander
Black (Not Hispanic)
Hispanic
Native American
White (Not Hispanic)
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Mother’s Information
Mom's Name
*
First Name
Last Name
Mom's Phone Number
Mom's Annual Income
*
Moms' Zip Code
*
Moms' Attorney
First Name
Last Name
Moms' Attorney Phone Number
Father’s Information
Dad's Name
*
First Name
Last Name
Dad's Phone Number
Dad's Annual Income
*
Dad's Zip Code
*
Dad's Attorney
First Name
Last Name
Dad's Attorney Phone Number
Specific Objective or Legal Issue establishing need for GAL:
Submitter's Email (Required for reply):
*
example@example.com
Submit
Should be Empty: