Appendix A-7 Guardian Ad Litem / Court Appointed Counsel Roster Application
Baldwin's Kentucky Revised Statutes Annotated8th Judicial Circuit - Warren Family Court
KY RWFC App. A-7
Appendix A-7 Guardian Ad Litem / Court Appointed Counsel Roster Application
COMMONWEALTH OF KENTUCKY
8th JUDICIAL CIRCUIT
WARREN CIRCUIT COURT
FAMILY COURT
GUARDIAN AD LITEM/COURT APPOINTED COUNSEL
ROSTER APPLICATION
Please complete the following application and submit this along with relevant documentation to the Warren Circuit Family Court Administrator.
Name: |
Business Address: |
City: ____________ State: ____________ Zip Code: |
Business Telephone: ____________________ Fax: |
Email: |
I. EDUCATION, TRAINING AND EXPERIENCE |
GENERAL EDUCATIONAL BACKGROUND |
Degree | Institution | Location | Date | |
KENTUCKY BAR INFORMATION | |
KBA ID Number: | |
GUARDIAN AD LITEM TRAINING* | |
Date | Program | Sponsor | Hours | |
OTHER TRAINING RELEVANT TO FAMILY LAW* | |
Date | Program | Sponsor | Hours | |
Do you have any prior KBA Ethics violations or sanctions? YES or NO. |
If yes, please explain: | |
Do you have any scheduling conflicts with either Family Court juvenile docket? YES or NO. |
If yes, please explain: | |
Are you willing to be appointed in juvenile, circuit, and adoption/ termination of parental rights cases? YES or NO. |
(Attorneys must be willing to serve in any or all jurisdictions of the Family Court). |
II. REFERENCES |
Please list two persons, not related to you, who are familiar with the skills you have that will make you a successful guardian ad litem/ court-appointed counsel. |
Name: |
Address: |
City: _______________ State: _______________ Zip: |
Telephone: ____________________ Fax: |
Name: |
Address: |
City: _______________ State: _______________ Zip: |
Telephone: ____________________ Fax: |
III. BACKGROUND REVIEW AND PROFESSIONAL ETHICS |
Have you been convicted of any crime or violation other than a traffic infraction? |
[ ] Yes | [ ] No |
Have you been removed, suspended, reprimanded or subject to any other discipline by a licensing board, professional organization, or governmental tribunal? |
[ ] Yes | [ ] No |
Have you ever been a party, other than acting as guardian ad litem/court-appointed counsel or private counsel, to a child protective case brought pursuant to KRS Chapter 625, or to a similar case in any other jurisdiction? |
[ ] Yes | [ ] No |
Have you ever been a party, other than acting as guardian ad litem/court-appointed counsel or private counsel, to a domestic violence action brought pursuant to KRS Chapter 403, or to a similar case in any other jurisdiction? |
[ ] Yes | [ ] No |
(If your answer is yes to any of the four previous questions, please provide full details on a separate sheet, including any information you believe may be helpful to the Guardian ad Litem/Court-Appointed Counsel Committee in evaluating your application.) |
Are you a member of any family law professional organization? If yes, please specify: |
IV. AFFIRMATIONS, CONDITIONS OF APPLICATION, AND RELEASE |
I understand that any misrepresentation in my application may constitute a basis for the rejection of my application or removal of my name from the Guardian ad Litem/Court-Appointed Counsel Roster. |
I hereby affirm that the information provided by me in this application form is accurate and complete under penalty of law. |
Signature | Date |
Credits
HISTORY: Amended effective April 4, 2012.
Footnotes
Please attach relevant documentation.
Warren Family Court App. A-7, KY R WARREN FAM CT App. A-7
Current with amendments received through November 15, 2023. Some rules may be more current, see credits for details.
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