Form 10-529. Acceptance of court-appointed special advocate in child welfare proceedings.

STATE OF NEW MEXICO COUNTY OF _______________ __________________ JUDICIAL DISTRICT IN THE CHILDREN’S COURT STATE OF NEW MEXICO ex rel. CHILDREN, YOUTH AND FAMILIES DEPARTMENT No. __________ In the Matter of _______________________________, a Child,1 and Concerning _______________________________, Respondent.2 ACCEPTANCE OF COURT-APPOINTED SPECIAL ADVOCATE (CASA) COMES NOW ______________ and accepts the appointment as the court- appointed special advocate (CASA) for this case. My signature below certifies that I assert and agree as follows: 1. I meet the qualifications to serve as a CASA because a. I am at least twenty-one (21) years of age; b. I have successfully passed screening requirements, including a written application, personal interview, reference checks, and criminal records checks; c. I have successfully completed initial and regular in-service training; and d. I remain under the supervision of the local CASA director; 2. I have read and I understand the confidentiality requirements of Rule 10-166 NMRA and NMSA 1978, Sections 32A-4-33 and 32A-3B-22, and I agree to abide by these provisions. I will maintain and destroy notes, reports, and documents in a manner that maintains privacy and confidentiality, and I will not keep any information or documents when I am relieved of my appointment; 3. I have read the Order Appointing Court-Appointed Special Advocate (CASA) and understand my specific duties and the court’s expectations; 4. I understand the court expects forthright and honest assessments from me as the court is relying on my observations to make important decisions about this family. At regular intervals, I will discuss the case and its progress with the following individuals and entities, as applicable to the case: the Children, Youth and Families Department’s Permanency Planning Worker, the Children’s Court Attorney, the respondent, the attorney for the respondent, the child’s guardian ad litem or attorney, the foster parent(s), [the tribal Indian Child Welfare Act (ICWA)/Indian Family Protection Act (IFPA) worker,]3 the child’s teachers, the child’s medical providers, the child’s therapists, the child’s counselors, and any other community or service providers for the family; 5. I understand that, prior to adjudication in this case, I shall not interview any respondent to this case unless that respondent’s attorney has consented to the interview; 6. I understand that I must prepare and submit reports to the court at least five (5) days before any hearing in this case at which the report will be considered. I will abide by the requirements for pre- and post-adjudication reports as described in Rule 10-164, and provide a copy of my report to all parties to the case[, including the tribal ICWA/IFPA worker];3 7. I understand that I may attend any hearing set for this case; 8. I understand that I may supplement or correct my written report during a court hearing; and 9. I will promptly request to be relieved of my appointment if I fall out of compliance with Rule 10-164 or if I am no longer a CASA volunteer. WHEREFORE, I respectfully request that this Court accept my appointment as the CASA for this case. Respectfully Submitted, __________________________ Name of CASA: ________________________________________________ Office Address: ________________________________________________ Office Phone Number: ________________________________________________ Office Email: ________________________________________________ Certificate of Service I certify that a copy of this Acceptance of Court-Appointed Special Advocate has been provided to all attorneys for this case [and the tribal ICWA/IFPA representative]3 on the date of filing. __________________________ CASA Parties Entitled to Copies Children’s Court Attorney: __________________________________ Child’s Guardian ad litem or Attorney: __________________________________ Respondent Attorney: __________________________________ [Tribal ICWA/IFPA representative: __________________________________ (the Department shall file a certificate of service demonstrating that the Indian Tribe(s) and/or Bureau of Indian Affairs Regional Office was/were served a copy of this order within five (5) business days of the order’s issuance.)] 3