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Juvenile Court Improvement Program
1163 State Street
Salem, OR 97301-2563

Phone: 503.986.5618
Fax: 503.986.5859
Oregon Relay Service-711


JCIP Model Judgment Forms (Dependency) - Fillable - Updated October 2014

These forms are in Microsoft Word and are "fillable."  They are intended to be completed electronically, either in advance or on the bench.  The forms are "locked" so you can only type in the grey fields.  If you need to modify the form for your local court, please contact JCIP to obtain the password and instructions.

NOTE: If you are using Word 2010 or 2013, the fillable features may not work properly.  If you are unable to access and use these forms as intended, please email Megan Carsley at, or call 503.986.5618. 

2014 Model Form Update - Summary of changes made to the model forms in 2014.
JF2: Shelter Order 
This form complies with the requirements of ORS 419B.185 for non-ICWA cases.  If the case falls under ICWA, use the JF2i form instead.
JF2i: Shelter Order ICWA Cases
This form complies with the requirements of ORS 419B.185 and the Indian Child Welfare Act (ICWA). 
JF3: Jurisdiction Judgment
Use this form when the court will not enter a disposition judgment at the time the jurisdiction judgment is entered.
JF4: Disposition Judgment
Use this form when the court determines jurisdiction and orders disposition in separate proceedings at different times.
JF4B: Jurisdiction and Disposition Judgment
Use this form when the court determines jurisdiction and orders disposition as part of the same proceeding. 
JF5: Permanency Judgment
This form complies with the requirements of ORS 419B.470 and 419B.476 and should be used for all permanency hearings. 
JF6: Review Judgment
Use this form for review hearings that are required, or authorized, by ORS 419B.449.  For “limited” review hearings – i.e., those held to resolve questions that do not require all the findings required by ORS 419B.449 -- use form JF6B.  
JF6B: NON – ORS 419B.449 Review Judgment
Use this form for review hearings held to resolve questions that do not require all the findings required by ORS 419B.449.
Guardianships created in juvenile court require an annual written report from the guardian.  This form is the letter sent to the guardian by the court describing this requirement and the form the guardian uses to comply.
JF27: Admission Form
Many courts require or permit parents to make admissions to dependency petitions in writing. This form provides them with a model template. (See JF 3 above.)

Optional Forms for Juvenile Dependency Cases

These have not been reviewed for legal sufficiency and are not endorsed by JCIP.


JF0: Advice of Rights – Model Narrative
This narrative is intended to be read aloud to the parties involved in dependency proceedings.  It covers basic legal rights and important considerations relating to court processes and child placements. 

JF1: Court Appearance Sheet
This format of a court appearance sheet for dependency cases is provided as a guide for local courts.  In courts where a court clerk is present, the clerk would normally fill this out.  It is completed once for each court appearance no matter how many of the other forms are used.  It lists the types of hearings with the appropriate OJIN code to speed up data entry after the hearing.  It includes places to show who appeared, what was done, and what the next hearing date and time is.  This form is used in Linn County.  An alternative form of appearance sheet is JF17, which is the format used in Marion County.

JF7: Juvenile Court Restraining Order
This is the restraining order to keep alleged offenders out of the child’s home provided for in ORS 419B.845.  The first page is the restraining order itself; the second page is the notice to law enforcement so they know it is not a FAPA order and the notice to the person restrained of his/her rights.

JF8: Judgment Dismissing Restraining Order

JF9: Order of Continuance
This form allows for continuance of a dependency case beyond the 60-day limit for jurisdiction.  The court must make specific findings for why there is good cause to continue the case beyond the 60-day jurisdiction limit. 

JF10: Special Circumstances Findings and Judgment
This form is used when the Court must make special findings of aggravated circumstances under ORS 419B.340 or a finding of prior convictions under those provisions.  This is a rare occurrence in most courts and they may choose not to adopt a form for this purpose and have counsel draft one in the cases where the findings are needed.  Although the statute does not specifically state that the Court cannot relieve DHS of providing active efforts, it is recommended the Court never excuse DHS from making active efforts in cases govern by the ICWA.  Provisions excusing active efforts have been excluded from this form. 

JF11: Notice to Parents
This form complies with the requirements of ORS 419B.117.

JF11: Notice to Parents (Spanish)
This form complies with the requirements of ORS 419B.117 and has been translated into Spanish.

JF12: Compelling Reasons Order
This form is used if the child is placed outside the home for 15 out of 22 months.  In most cases, it would be completed, if necessary, with the permanency order (JF5) at the first annual review unless the time line in the case is skewed, and the annual review does not coincide closely with the 15-month deadline.

JF13: Compelling Reasons Determination Notice
If the 15 month deadline does not coincide closely with the annual review, the court may choose to send out this notice and make the Compelling Reasons determination in chambers, subject to the right to a hearing if requested.  Courts may elect to hold hearings in lieu of sending this notice.

JF14: Consolidation Order
This order allows the court to make the decisions about consolidation and stay of proceedings as provided for and required in ORS 419B.806.

JF15: Commitment Judgment and Order to DHS
This form is intended only for use in delinquency cases where the youth is placed in the custody of DHS rather than OYA.

JF16: CASA Appointment Order

JF17: Status Sheet
This optional form or a variation of it is used in some counties to keep a log of file activity.  It is kept at the top of the file so that at a glance the court can determine what has occurred or not occurred in the case without looking through the entire file.

JF18: Notice of Juvenile Proceeding and Request for Information
This form was provided by the DOJ.  It should be sent to DOJ whenever a circuit court case is pending that may affect child support.

JF19: Motion for Guardianship
The Motion used to seek the Guardianship finalized by JF 22 (Judgment Establishing Guardianship).

JF20: Petition for Permanent Guardianship
Petition to establish a permanent guardianship under ORS 419B.365.  As required by statute, this form contains the same evidentiary standards and findings required in a termination of parental rights proceeding. 

JF20B: Admission to Guardianship Form
This form was developed for parents and guardians who enter an admission or no contest to a petition to establish a guardianship.

JF20C: Judgment Terminating Guardianship
The 2003 Legislature created a “Juvenile Court Guardianship” procedure that allows a guardianship to be created in the juvenile court proceeding without filing a separate guardianship under ORS 125.005 et seq.  Since self represented parties will often want to file these in juvenile cases, the required pleadings are made available here.  Local courts can in turn make these available to the public.

JF22: Judgment Establishing Guardianship
This form can be used for either type of juvenile court guardianship.  ORS 419B.365 (Permanent Guardianship) or ORS 419B.366. 

JF23: Parent Address and Information Sheet
ORS 419A.106(3) requires that courts inquire and update address and phone information for parents and guardians.  This form, to be provided to parents at each appearance, can be completed if the information has changed.  It is formatted to allow two forms per page.

JF24: Affidavit in Support of Order for Protective Custody
Although DHS will likely present their own form, this form addresses the basic elements required to initiate juvenile dependency proceeding.

JF25: Motion, Affidavit and Order Appointing Educational Surrogate

JF26: Order Authorizing Protective Custody
This form provides for Court supervised legal authorization for the removal or pick up of a child.  Some courts refer to this form as a “pick up” order.  Some courts do not engage in pre-removal judicial review at all.