Form JD-JM-178 "Order to Provide Educational Records and Receipt" - Connecticut

What Is Form JD-JM-178?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-JM-178 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-JM-178 "Order to Provide Educational Records and Receipt" - Connecticut

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ORDER TO PROVIDE EDUCATIONAL
STATE OF CONNECTICUT
For information on ADA
RECORDS AND RECEIPT
SUPERIOR COURT
accommodations,
contact a court clerk or go to:
JD-JM-178 Rev. 9-20
JUVENILE MATTERS
C.G.S. §§ 46b-120; 46b-121
www.jud.ct.gov/ADA.
www.jud.ct.gov
Address of Court
Telephone number
Docket number
Name of child
Grade
Sex
Date of birth
Address of child
Indian tribe/reservation if any
Name of mother
Address of mother
Name of father
Address of father
Name of guardian, if any
Address of guardian
Name of school
Address of school
Name and title of contact person at school
Telephone number
Fax number
Case type
Child Protection
Delinquency
Emancipation
Other
The child named above currently has a case pending before the Superior Court for Juvenile Matters.
For purposes of determining (Select all that apply):
the need for services
placement of the child
final disposition of the case
Order
The following records are ordered to be provided to the Court location listed above by ___________________:
school transcript
academic performance
(date)
types of school programs
school behavior
enrollment status
expulsion and suspension
attendance reports
meetings with parents
special education
other
If records are incomplete or do not exist, please attach an explanation for the Court.
Name of Judge
Judge's signature
Date
Records produced in response to the above order shall be:
— used only for dispositional purposes and
— maintained under seal by the Court and
— released only after a hearing or with the consent of the child
Receipt/Response to Order
Please acknowledge receipt of the court order for educational records by signing below and returning the records to the
requesting Superior Court for Juvenile Matters. (Select all that apply:)
school transcript
academic performance
types of school programs
school behavior
enrollment status
currently expelled
attendance reports
meetings with parents
special education
other
explanation for any incomplete or non-existent
records requested
I certify that the items selected above are complete and accurate copies.
Signed
Name of person signing at left
Title
Date
Print Form
Reset Form
ORDER TO PROVIDE EDUCATIONAL
STATE OF CONNECTICUT
For information on ADA
RECORDS AND RECEIPT
SUPERIOR COURT
accommodations,
contact a court clerk or go to:
JD-JM-178 Rev. 9-20
JUVENILE MATTERS
C.G.S. §§ 46b-120; 46b-121
www.jud.ct.gov/ADA.
www.jud.ct.gov
Address of Court
Telephone number
Docket number
Name of child
Grade
Sex
Date of birth
Address of child
Indian tribe/reservation if any
Name of mother
Address of mother
Name of father
Address of father
Name of guardian, if any
Address of guardian
Name of school
Address of school
Name and title of contact person at school
Telephone number
Fax number
Case type
Child Protection
Delinquency
Emancipation
Other
The child named above currently has a case pending before the Superior Court for Juvenile Matters.
For purposes of determining (Select all that apply):
the need for services
placement of the child
final disposition of the case
Order
The following records are ordered to be provided to the Court location listed above by ___________________:
school transcript
academic performance
(date)
types of school programs
school behavior
enrollment status
expulsion and suspension
attendance reports
meetings with parents
special education
other
If records are incomplete or do not exist, please attach an explanation for the Court.
Name of Judge
Judge's signature
Date
Records produced in response to the above order shall be:
— used only for dispositional purposes and
— maintained under seal by the Court and
— released only after a hearing or with the consent of the child
Receipt/Response to Order
Please acknowledge receipt of the court order for educational records by signing below and returning the records to the
requesting Superior Court for Juvenile Matters. (Select all that apply:)
school transcript
academic performance
types of school programs
school behavior
enrollment status
currently expelled
attendance reports
meetings with parents
special education
other
explanation for any incomplete or non-existent
records requested
I certify that the items selected above are complete and accurate copies.
Signed
Name of person signing at left
Title
Date
Print Form
Reset Form