Juvenile Complaint Form
Families in Need of Services / Youth Empowerment Center
What program are you referring to?
*
Families in Need of Services (FINS)
Youth Empowerment Center (YEC)
Child's Information
Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Please Select
Male
Female
N/A
Race
Please Select
American Indian/Alaska Native
Asian
Black/African American
Hispanic/Latino
Native Hawaiian/Pacific Islander
White/Caucasian
Child's Social Security Number
Present Location of Child
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PARENT(S) / GUARDIAN(S) / CARETAKER(S) INFORMATION
Relationship to Client
PARENT
GUARDIAN
CARETAKER
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to Client
PARENT
GUARDIAN
CARETAKER
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous/Current Services Provided for Family/Child
What Services are currently being provided to the family?
Dept. of Children & Family Services OCS/OJJ
Probation
Counseling/Mental Health Services
Substance Abuse/Drug Services
Educational/Tutoring
Mentoring
Other
Please give agency name and contact information for each service provided
FINS Grounds
That a child is truant or has willfully & repeatedly violated lawful school rules
That a child is ungovernable
That a child is a runaway
That a child has repeatedly possessed or consumed intoxicating beverages, or that he has misrepresented or deceived his age for the purpose of purchasing or receiving such beverages from a person, or has repeatedly loitered around any place where such beverages are the principle commodities sold or handled.
That a child has committed an offense applicable only to children.
That a child under ten years of age has committed any act, which if committed by an adult would be a crime under any federal, state, or local law.
That a caretaker has caused, encouraged, or contributed to the child's behaviors enumerated in Article VIII or to the commission of delinquent acts as defined in Title VII.
That, after notice, a caretaker has willfully failed to attend a meeting with the child's teacher, school principal, or other appropriate school employee to discuss the child's truancy, the child's repeated violation of school rules, or other serious educational problems of the child.
That a child has been found incompetent to proceed with a delinquency mater under Art. 832 et seq.
A child found to have engaged in cyber bullying.
In the space below please describe any incident regarding the above marked allegations including the date of occurrence, place of occurrence, and the names and contact information for any witnesses to the incident.
YEC Grounds
Battery on a School Teacher
Criminal Mischief
Criminal Property Damage
Criminal Trespass
Disturbing the Peace
Domestic Abuse
Domestic Battery
Fighting
Illegal Possession of Firearm
Illegal Possession of Stolen Things
Interference
Obstruction of Justice
Obstructing Public Passages
Possession of Alcohol
Possession of Marijuana
Possession of Tobacco
Possession of Vapor Product
Resisting Arrest
Runaway
Misd. Sexual Battery
Simple Assault
Simple Battery
Theft
Trespassing
Truancy
Ungovernable Juv.
Unlawful Phone Communication
Unlawful Disruption of School
Other
Referring Party's Information
Name
*
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Referring Party's Agency Affiliation
*
Bossier Parish Schools
Bossier Parish Sherriff's Office
Caddo Parish Schools
Caddo Parish Sherriff's Office
Shreveport Police
Parent/Guardian/Caretaker
Other
Submit
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