Form JD-FM-149 "Parenting Education Program - Order, Certificate and Results" - Connecticut

What Is Form JD-FM-149?

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 November 1, 2012;
  • 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-FM-149 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-FM-149 "Parenting Education Program - Order, Certificate and Results" - Connecticut

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PARENTING EDUCATION
FOR COURT USE ONLY
STATE OF CONNECTICUT
PROGRAM - ORDER,
SUPERIOR COURT
ORDPEP (Order for participation)
CERTIFICATE AND RESULTS
www.jud.ct.gov
FNOPEPF (Finding of inability to pay)
JD-FM-149 Rev. 11-12
CERTPEP (Certification of results)
C.G.S. §§ 46b-1, 46b-56, 46b-69b, 46b-231(m)(12)
Court Location
Instructions — Press Hard, you are making 4 copies.
To person taking part in the program:
To Clerk:
1. Provide name of case and docket number if available in designated boxes.
1. If program participation is ordered by the court or family support
magistrate, enter court location above and docket number and
2. Complete Section 2 if you are attending the Program to comply with the
complete section 1.
Automatic Orders or to comply with an order of the court or family support
2. Keep gold copy and give original and remaining copies to participant.
magistrate.
3. If you believe you are unable to pay or indigent, complete and submit form
To Service Provider:
JD-FM-75, Application for Waiver of Fees/Appointment of Counsel Family
1. Complete Section 3 and return original and green copy to the
appropriate Family Division Office.
before attending the program.
2. Give/send pink copy to participant.
4. YOU MUST bring this form and any approved Fee Waiver form to the
3. Keep yellow copy for your records.
service provider.
5. Select a service provider from a list available at the clerk's office and
To Family Services:
contact that provider to arrange attendance and to tell it the name of any
1. Upon receipt of Completion Certificate from service provider, complete
person that you do not want to be with in the same program.
section 4 and forward original to the superior court listed.
6. Give the original and ALL copies of the form to the service provider.
2. Keep green copy for your records.
Name of case (Plaintiff vs. Defendant)
Docket number
Section 1 - Court Order/Family Support Magistrate Order
(To be completed by Clerk)
Name of participant (Person taking part in the program)
(Select One)
Court Order
OR
Family Support Magistrate Order
The participant named above has been ordered to take
All parties being present before the Family Support Magistrate
part in a parenting education program established
Division, it is ordered that the participant named above take part in a
under Section 46b-69b of the Connecticut General
parenting education program established under Section 46b-69b of
Statutes. The court finds that this individual:
the Connecticut General Statutes. It is found that participation is
necessary and that this individual:
(Select One)
Is Able to pay directly to the service provider the
OR
Is Indigent or Unable to pay to take part in a parenting
appropriate fee for participating in a parenting
education program and all costs for participation in a program shall
education program.
be covered by the service provider under the provisions of Section
46b-69b of the Connecticut General Statutes.
By the Court/Family Support Magistrate Division (Print or type name of Judge/FSM)
Date Ordered
Signed (Judge, FSM, Assistant Clerk)
Section 2 - Participant Information
(To be completed by Participant - print or type)
Name and address of participant (Number, street, town and zip code)
"X" if applicable
I request not to be assigned to the same group as:
(Name of person)
"X" this box if you are attending the parenting education program to comply with the Automatic Orders (Section 25-5 of the Connect-
icut Practice Book).
Section 3 - Completion Certificate
(To be completed by Service Provider)
Name of Service Provider
Date(s) of Participation
Location at Which Program Was Provided
To: The Court Support Services Division, Family Services Unit of the Superior Court
The participant named above was scheduled to participate in our Parenting Education Program. It is certified that the participant:
satisfactorily completed the program.
did not satisfactorily complete the program for the following reason(s):
lack of attendance
other (specify):
Signed (Authorized Person)
Print or Type Name of Person Signing at Left
Date Signed
Section 4 - Participation Results
(To be completed by Family Services)
To: The Superior Court
The Court Support Services Division, Family Services Unit of the Superior Court certifies the results of participation as indicated above.
Print or Type Name of Person Signing at Left
Date Signed
Signed (Authorized Family Division Person)
Print Form
Reset Form
PARENTING EDUCATION
FOR COURT USE ONLY
STATE OF CONNECTICUT
PROGRAM - ORDER,
SUPERIOR COURT
ORDPEP (Order for participation)
CERTIFICATE AND RESULTS
www.jud.ct.gov
FNOPEPF (Finding of inability to pay)
JD-FM-149 Rev. 11-12
CERTPEP (Certification of results)
C.G.S. §§ 46b-1, 46b-56, 46b-69b, 46b-231(m)(12)
Court Location
Instructions — Press Hard, you are making 4 copies.
To person taking part in the program:
To Clerk:
1. Provide name of case and docket number if available in designated boxes.
1. If program participation is ordered by the court or family support
magistrate, enter court location above and docket number and
2. Complete Section 2 if you are attending the Program to comply with the
complete section 1.
Automatic Orders or to comply with an order of the court or family support
2. Keep gold copy and give original and remaining copies to participant.
magistrate.
3. If you believe you are unable to pay or indigent, complete and submit form
To Service Provider:
JD-FM-75, Application for Waiver of Fees/Appointment of Counsel Family
1. Complete Section 3 and return original and green copy to the
appropriate Family Division Office.
before attending the program.
2. Give/send pink copy to participant.
4. YOU MUST bring this form and any approved Fee Waiver form to the
3. Keep yellow copy for your records.
service provider.
5. Select a service provider from a list available at the clerk's office and
To Family Services:
contact that provider to arrange attendance and to tell it the name of any
1. Upon receipt of Completion Certificate from service provider, complete
person that you do not want to be with in the same program.
section 4 and forward original to the superior court listed.
6. Give the original and ALL copies of the form to the service provider.
2. Keep green copy for your records.
Name of case (Plaintiff vs. Defendant)
Docket number
Section 1 - Court Order/Family Support Magistrate Order
(To be completed by Clerk)
Name of participant (Person taking part in the program)
(Select One)
Court Order
OR
Family Support Magistrate Order
The participant named above has been ordered to take
All parties being present before the Family Support Magistrate
part in a parenting education program established
Division, it is ordered that the participant named above take part in a
under Section 46b-69b of the Connecticut General
parenting education program established under Section 46b-69b of
Statutes. The court finds that this individual:
the Connecticut General Statutes. It is found that participation is
necessary and that this individual:
(Select One)
Is Able to pay directly to the service provider the
OR
Is Indigent or Unable to pay to take part in a parenting
appropriate fee for participating in a parenting
education program and all costs for participation in a program shall
education program.
be covered by the service provider under the provisions of Section
46b-69b of the Connecticut General Statutes.
By the Court/Family Support Magistrate Division (Print or type name of Judge/FSM)
Date Ordered
Signed (Judge, FSM, Assistant Clerk)
Section 2 - Participant Information
(To be completed by Participant - print or type)
Name and address of participant (Number, street, town and zip code)
"X" if applicable
I request not to be assigned to the same group as:
(Name of person)
"X" this box if you are attending the parenting education program to comply with the Automatic Orders (Section 25-5 of the Connect-
icut Practice Book).
Section 3 - Completion Certificate
(To be completed by Service Provider)
Name of Service Provider
Date(s) of Participation
Location at Which Program Was Provided
To: The Court Support Services Division, Family Services Unit of the Superior Court
The participant named above was scheduled to participate in our Parenting Education Program. It is certified that the participant:
satisfactorily completed the program.
did not satisfactorily complete the program for the following reason(s):
lack of attendance
other (specify):
Signed (Authorized Person)
Print or Type Name of Person Signing at Left
Date Signed
Section 4 - Participation Results
(To be completed by Family Services)
To: The Superior Court
The Court Support Services Division, Family Services Unit of the Superior Court certifies the results of participation as indicated above.
Print or Type Name of Person Signing at Left
Date Signed
Signed (Authorized Family Division Person)
Print Form
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