Form AOC-JV-38.1 "Affidavit and Beyond Control of School Evaluation Form" - Kentucky

What Is Form AOC-JV-38.1?

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

Form Details:

  • Released on March 1, 2017;
  • The latest edition provided by the Kentucky Court of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form AOC-JV-38.1 by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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Download Form AOC-JV-38.1 "Affidavit and Beyond Control of School Evaluation Form" - Kentucky

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AOC-JV-38.1
Doc. Code: ABCSE
CDW Referral No. _____________
Rev. 3-17
Juv Id: __________
Page 1 of 2
l e x
Case No. ____________________
e t
j u s t i t i a
Commonwealth of Kentucky
Court
[ ] Family
[ ] District
Court of Justice
www.courts.ky.gov
AFFIDAVIT AND BEYOND CONTROL OF
County ______________________
SCHOOL EVALUATION FORM
FCRPP40
Demographic Information:
Name:
DOB:
Grade:
Race:
Gender:
School:
SSN:
Mother:
Father:
Other Legal Guardian(s):
Relationship:
q 504 Plan
q IEP (Last ARC Date: ____________)
Student resides with:
(Please check all that apply)
q Both Parents
Parent's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Mother
Mother's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Father
Father's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Other/Legal Guardian
Other/Legal Guardian Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
Truancy Information:
Total Absences:
Absences Unexcused:
Total Tardies:
Tardies Unexcused:
School Issues:
(Please check all that apply)
q Skipping School
q Skipping Classes
q Behavior Issues
q Low Academic Performance
q Suspensions (# of events ____)
q Suspected Gang Involvement
q Suspected Drug Involvement
q Suspected Alcohol Use
q Bullying
q Poor Peer Relationships
q Tobacco Use
q Safety Concerns/Fighting
Describe School Concerns:
AOC-JV-38.1
Doc. Code: ABCSE
CDW Referral No. _____________
Rev. 3-17
Juv Id: __________
Page 1 of 2
l e x
Case No. ____________________
e t
j u s t i t i a
Commonwealth of Kentucky
Court
[ ] Family
[ ] District
Court of Justice
www.courts.ky.gov
AFFIDAVIT AND BEYOND CONTROL OF
County ______________________
SCHOOL EVALUATION FORM
FCRPP40
Demographic Information:
Name:
DOB:
Grade:
Race:
Gender:
School:
SSN:
Mother:
Father:
Other Legal Guardian(s):
Relationship:
q 504 Plan
q IEP (Last ARC Date: ____________)
Student resides with:
(Please check all that apply)
q Both Parents
Parent's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Mother
Mother's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Father
Father's Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
q Other/Legal Guardian
Other/Legal Guardian Resident Address:
Mailing Address(if different than above):
Home Phone:
Cell Phone:
Work Phone:
Truancy Information:
Total Absences:
Absences Unexcused:
Total Tardies:
Tardies Unexcused:
School Issues:
(Please check all that apply)
q Skipping School
q Skipping Classes
q Behavior Issues
q Low Academic Performance
q Suspensions (# of events ____)
q Suspected Gang Involvement
q Suspected Drug Involvement
q Suspected Alcohol Use
q Bullying
q Poor Peer Relationships
q Tobacco Use
q Safety Concerns/Fighting
Describe School Concerns:
AOC-JV-38.1
Rev 3-17
Page 2 of 2
Interventions By School:
q Phones Calls to Parent
q Referral to Youth Services Center (FRYSC)
q Letters Sent to Parent
q Referral to Guidance Counselor
q Parent Conference
q Referral to Social Services
q Student Conference
q Referral to Mental Health Services
q Home Visits
q Referral to Medical Services
q Other Interventions: ____________________________________________________________________________
____________________________________________________________________________
What expectations do you have upon filing the complaint?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________.
This form was:
Prepared by: _____________________________________________
________________________
Name
Title
_____________________________________________
________________________
Phone No. and Email
Date
Affidavit
I, _____________________________________, the undersigned Affiant, state that I have read the foregoing
and that the matters stated herein are true to the best of my information, knowledge, and belief.
____________________________________________
Signature
____________________________________________
Printed name
SWORN TO before me this _________ day of ___________________________, 2_____.
Name _________________________________________
Title ________________________________________
List of Attachments: l Attendance Record of Unexcused Absences/Tardies
Discipline Report
l
Grade Report
l
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