State of Alabama Unified Judicial System Form JU–12B Rev. 6/13
LEGAL INFORMATION (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF _________________________________________________ COUNTY, ALABAMA
(Name of County) In the Matter of _______________________________________________________________________, a child Part I PRIOR JUVENILE COURT RECORD:
Date Offense / Matter Disposition
Part II CHILD’S ATTITUDES TOWARD CURRENT OFFENSE AND HIS STATEMENT:
Part III COMPLAINANT’S (Victim’s) STATEMENT AND ATTITUDES TOWARD CURRENT OFFENSE:
Part IV PARENT’S ATTITUDES TOWARD OFFENSE: Part V PARENT’S PRIOR POLICE RECORD: _________________________________ _______________________________________________ Date Signature of Juvenile Probation Officer
(Name of Child)
State of Alabama Unified Judicial System Form JU-12C Rev. 6/13
SCHOOL INFORMATION (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF ____________________________________________________________COUNTY, ALABAMA (Name of County) In the Matter of___________________________________________________________________________________, a child Current School:____________________________________________________________________________________________ Schools Previously Attended:_________________________________________________________________________________
Grades Repeated (if applicable):______________________________________________________________________________ Present Grade: __________________ Test Given:______________________ Date Results: ________________________ Given:_______________________ Functional Grade Level: ________________ Academic Record: Record Attached, Report card, etc. Attendance: Required Days: ______________________________ Days Present: ________________________________ Excused Absences: ____________________________ Unexcused Absences: __________________________ Conduct Reports, Behavior, Attitude Towards School & Persons in Authority: _______________________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Extracurricular Activities: _______________________________________________________________________________________________ _______________________________________________________________________________________________ School Officials Contacted: _____________________________________________________________________________________________ _____________________________________________________________________________________________ Phone: ________________________________ ___________________________________ _______________________________________________ Date Signature of School Official ___________________________________ _______________________________________________ Date Signature of Juvenile Probation Officer
Current Year Last Year Subject 1 2 3 4 5 6 Yr. Subject 1 2 3 4 5 6 Yr.
1. 1. 2. 2. 3. 3. 4. 4. 5. 5. 6. 6.
(Name of Child)
State of Alabama Unified Judicial System Form JU – 12D Rev. 6/13
PROFILE OF CHILD (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF ___________________________________________________________ COUNTY, ALABAMA
(Name of County)
In the Matter of ___________________________________________________________________________________, a child
A profile of the child should include comments about physical appearance; self-image (how the child sees himself/herself); general attitude towards authority, parents, school and police; peer relationships; strengths, weaknesses, and attributes the child has that could help him/her through problems; employment history (full-time and part-time); interests, hobbies and activities; special placements (i.e., special education, foster homes, vocational rehabilitation, etc); description of programs and adjustment, length of stay, reasons for removal; and other pertinent comments or analysis.
__________________________________ _____________________________________________ Date Signature of Juvenile Probation Officer
(Name of Child)
State of Alabama Unified Judicial System Form JU-12E Rev. 6/13
FAMILY–HOME INFORMATION (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF _____________________________________________________________COUNTY, ALABAMA
(Name of County) In the Matter of ____________________________________, a child Age: _________ Sibling Rank By Birth: ____________ Description of Home: Family Information: Comment on all pertinent information about the child’s family, and income; parents’ marital status and marital history; medical problems; recurring illnesses, mental or physical; family activities; general relationships among parents, child, child’s siblings; attitude of parents toward offense; etc. Other agencies working with family or individual member: (Past or present) _________________________________ _________________________________________________________ Date Signature of Juvenile Probation Officer
(Name of Child)
State of Alabama Unified Judicial System Form JU–12F Rev. 6/13
MEDICAL INFORMATION (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF _______________________________________________ COUNTY, ALABAMA
(Name of County) In the Matter of _________________________________________________________________________, a child Health History: Physical History (List diseases, physical handicaps, or surgical history): Last Physical Exam (date, doctor, results): Name of Family Doctor: ____________________________ Hospital Plan: _______________________________
Office Address: __________________________________ Medicaid No.: _______________________________ ________________________________________________
Phone: ______________________________
Psychiatric History:
Immunizations – Childhood Diseases:
Other Comments: (Immediate problems, current treatments, habits, diet and other factors detrimental to health, medical complaints and problems)
_________________________________ ____________________________________________________ Date Signature of Probation Officer
(Name of Child)
State of Alabama Unified Judicial System Form JU-12G Rev. 6/13
SUMMARY – RECOMMENDATIONS (SOCIAL HISTORY SERIAL)
Court Case Number
IN THE JUVENILE COURT OF ______________________________________________COUNTY, ALABAMA
In the Matter of _______________________________________________________________________, a child Needs Assessment and Treatment Priorities (Specific areas or target behavior, i.e., cursing, constant fighting): Recommendations: Referral Resources That are Indicated: Other Comments: ________________________________ ____________________________________________________ Date Signature of Juvenile Probation Officer
(Name of County)
(Name of Child)
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