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					                               FAMILY DIVISION/FAMILY SERVICES
                           JURISDICTIONAL GRANT QUARTERLY REPORT

             Grant No.:                            Jurisdiction:                            FY:

             Quarter:           1st          2nd                   3rd               4th/Final


Please use this form to report on the activies and expenditures of the Circuit Court Family Division or Family
Services Program in the above jurisdiction. This report is due within 45 days after the end of each quarter as
described below.
                       1st Quarter (July 1 thru Sept 30)      Quarterly Report Due: Nov 15
                       2nd Quarter (Oct 1 thru Dec 31)        Quarterly Report Due: Feb 15
                       3rd Quarter (Jan 1 thru Mar 31)        Quarterly Report Due: May 15
                       4th Quarter (Apr 1 thr Jun 30)         Quarterly Report Due: Aug 15

             Please submit completed reports to:
                       Connie Kratovil-Lavelle, Executive Director
                       Department of Family Administration
                       Administrative Office of the Courts
                       580 Taylor Avenue
                       Annapolis, Maryland 21401
                       Phone: 410-260-1580


I. Administrative Personnel
Please check if the information below has changed.
Please identify applicable administrative personnel.

County Administrative Judge:

Family Division Administrative Judge:

Family Division Administrator/Coordinator:

Family Support Services Coordinator:


This Statistical and Narrative Report has been prepared and submitted by:



Name (printed)          Title                                      Approved by (printed)          Title



Signature        Date                                              Signature               Date
     Grant #   0                                      Jurisdiction:   0
     Quarter 1
II. Summary of New Initiatives
1. Judicial Officials (add rows as needed using "cut" & "paste")
        Current Judges Assigned to Family              New Judges Assigned to Family During Quarter
 1                                                      1
 2                                                      2
 3                                                      3
 4                                                      4
 5                                                      5
 6                                                      6
 7                                                      7
 8                                                      8
 9                                                      9
10                                                     10

            Visiting or Retired Judges Sitting in the Family Division During the Quarter
 1
 2
 3
 4
 5
 6
 7
 8
 9
10

        Current Masters Assigned to Family            New Masters Assigned to Family During Quarter
 1                                                     1
 2                                                     2
 3                                                     3
 4                                                     4
 5                                                     5
 6                                                     6
 7                                                     7
 8                                                     8
 9                                                     9
10                                                    10

2. Please describe the process by which litigants are determined to be eligible for fee waivers:




3. Were any new programs, services or major improvements undertaken this quarter? (Including any
new administrative, support or services staff positions that have been created and/or filled during the
quarter.)                Yes       No
IF YES, please describe below:
      Grant #   0                                       Jurisdiction:    0
      Quarter 2
II. Summary of New Initiatives
1. Judicial Officials (add rows as needed using "cut" & "paste")
        Current Judges Assigned to Family               New Judges Assigned to Family During Quarter
  1                                                       1
  2                                                       2
  3                                                       3
  4                                                       4
  5                                                       5
  6                                                       6
  7                                                       7
  8                                                       8
  9                                                       9
 10                                                      10

            Visiting or Retired Judges Sitting in the Family Division During the Quarter
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10

       Current Masters Assigned to Family               New Masters Assigned to Family During Quarter
  1                                                       1
  2                                                       2
  3                                                       3
  4                                                       4
  5                                                       5
  6                                                       6
  7                                                       7
  8                                                       8
  9                                                       9
 10                                                      10

2. Please describe the process by which litigants are determined to be eligible for fee waivers:




3. Were any new programs, services or major improvements undertaken this quarter? (Including any
new administrative, support or services staff positions that have been created and/or filled during the
quarter.)                         No
3. Were any new programs, services or major improvements undertaken this quarter? (Including any
new administrative, support or services staff positions that have been created and/or filled during the
quarter.)             Yes         No
IF YES, please describe below:
ring Quarter




uring Quarter
     Grant #   0                                        Jurisdiction:       0
     Quarter 3
II. Summary of New Initiatives
1. Judicial Officials (add rows as needed using "cut" & "paste")
         Current Judges Assigned to Family               New Judges Assigned to Family During Quarter
  1                                                        1
  2                                                        2
  3                                                        3
  4                                                        4
  5                                                        5
  6                                                        6
  7                                                        7
  8                                                        8
  9                                                        9
 10                                                       10

             Visiting or Retired Judges Sitting in the Family Division During the Quarter
 1
 2
 3
 4
 5
 6
 7
 8
 9
10

        Current Masters Assigned to Family              New Masters Assigned to Family During Quarter
 1                                                        1
 2                                                        2
 3                                                        3
 4                                                        4
 5                                                        5
 6                                                        6
 7                                                        7
 8                                                        8
 9                                                        9
10                                                       10

2. Please describe the process by which litigants are determined to be eligible for fee waivers:




3. Were any new programs, services or major improvements undertaken this quarter? (Including any new
administrative, support or services staff positions that have been created and/or filled during the quarter.)
                                No
3. Were any new programs, services or major improvements undertaken this quarter? (Including any new
administrative, support or services staff positions that have been created and/or filled during the quarter.)
                  Yes           No
IF YES, please describe below:
      Grant #    0                                     Jurisdiction:       0
      Quarter
II. Summary of New Initiatives
1. Judicial Officials (add rows as needed using "cut" & "paste")
        Current Judges Assigned to Family              New Judges Assigned to Family During Quarter
  1                                                       1
  2                                                       2
  3                                                       3
  4                                                       4
  5                                                       5
  6                                                       6
  7                                                       7
  8                                                       8
  9                                                       9
 10                                                      10

             Visiting or Retired Judges Sitting in the Family Division During the Quarter
  1
  2
  3
  4
  5
  6
  7
  8
  9
 10

       Current Masters Assigned to Family              New Masters Assigned to Family During Quarter
  1                                                       1
  2                                                       2
  3                                                       3
  4                                                       4
  5                                                       5
  6                                                       6
  7                                                       7
  8                                                       8
  9                                                       9
 10                                                      10

2. Please describe the process by which litigants are determined to be eligible for fee waivers:




3. Were any new programs, services or major improvements undertaken this quarter? (Including any new
administrative, support or services staff positions that have been created and/or filled during the quarter.)
                                 No
3. Were any new programs, services or major improvements undertaken this quarter? (Including any new
administrative, support or services staff positions that have been created and/or filled during the quarter.)
                  Yes            No
IF YES, please describe below:
III. Family Service/Program Report
                                                                                           Jurisdiction
                                                                                            does not
                                                                                           collect this
                                          1st Qtr  2nd Qtr   3rd Qtr   4th Qtr   YTD           info
                                              ADR Programs
Domestic Violence Screening
Please list (by role) those who are
responsible for screening for DV      →
 # Cases Screened                                                                      0
             In-person                                                                 0
             Not in-person                                                             0
       Mediation Programs
Custody/Visitation (non-CINA)
# Cases        Referred
                 Ordered                                                               0
# Held                                                                                 0
 # Agreements Reached                                                                  0
          Full Agreements:                                                             0
          Partial Agreements:                                                          0
Property/Financial
 # Cases      Referred
               Ordered                                                                 0
# Held                                                                                 0
 # Agreements Reached                                                                  0
          Full Agreements:                                                             0
          Partial Agreements:                                                          0
CINA/TPR
 # Cases      Referred
               Ordered                                                                 0
# Held                                                                                 0
 # Agreements Reached                                                                  0
          Full Agreements:                                                             0
          Partial Agreements:                                                          0
         Facilitator Program
 # Cases      Referred
              Ordered                                                                  0
# Held                                                                                 0
 # Agreements Reached                                                                  0
          Full Agreements:                                                             0
          Partial Agreements:                                                          0
       Settlement Conference
 # Cases      Referred
              Ordered                                                                  0
# Held                                                                                 0
 # Agreements Reached                                                                  0
          Full Agreements:                                                             0
          Partial Agreements:                                                          0
                                                                                                              Jurisdiction
                                                                                                               does not
                                                                                                              collect this
                                                1st Qtr       2nd Qtr   3rd Qtr       4th Qtr       YTD           info
      Scheduling Conference
# Cases     Referred
                  Ordered                                                                                 0
# Held                                                                                                    0
                    Other:
a.                                                                                                        0
b.                                                                                                        0
c.                                                                                                        0
d.                                                                                                        0
                                              Other Family Court Services
     Children's Attorney (Non-CINA)
      # of Attys appointed in each category
a. Best Interest Attorney                                                                                 0
b. Child Advocate                                                                                         0
c. Child's Privilege Attorney                                                                             0
         TOTAL # Attorneys Appointed                      0         0             0             0         0
          Children's Programs
a. Psycho-Educational (#children referred)                                                                0
b. Childcare/Waiting Room (#children)                                                                     0
 Child Custody Related Evaluations or
              Investigations
# Ordered                                                                                                 0
 # Completed (Counted by case)                                                                            0
               Home Visits
# Ordered                                                                                                 0
 # Completed (Counted by case)                                                                            0
           Visitation Services
Visitation
a. # Cases Referred                                                                                       0
b. # Cases Retained from Previous Qtr                                                                     0
c. # Supervised Visits Held                                                                               0
d. # Supervised Hours                                                                                     0
e. # Parents Utilizing Program                                                                            0
f. # Grandparents Utilizing Program                                                                       0
g. # Children Utilizing Program                                                                           0
h. # Cases Closed Successfully                                                                            0
i. # Cases Closed Unsuccessfully                                                                          0
j. # Cases Converted to Monitored Exchange                                                                0
Monitored Exchange
a. # Actual Exchanges                                                                                     0
b. # Parents Utilizing Program                                                                            0
c. # Grandparents Utilizing Program                                                                       0
d. # Children Utilizing Program                                                                           0
e. # Cases Closed Successfully                                                                            0
f. # Cases Closed Unsuccessfully                                                                          0
Emergency Assistance/Crisis Intervention
# Requests for Emergency Hearings                                                                         0
                                  # filed                                                                 0
                                                                                                      Jurisdiction
                                                                                                       does not
                                                                                                      collect this
                                          1st Qtr   2nd Qtr  3rd Qtr        4th Qtr       YTD             info
                                # granted                                                         0
Requests for Assistance (Domestic Relations ONLY) OPTIONAL
a. in person                                                                                      0
b. by phone                                                                                       0
                                 TOTAL:           0        0         0                0           0
         Mental Health Services
       Individuals Referred by Type
a. Psychological Evaluations                                                                      0
b. Psychiatric Evaluations                                                                        0
c. Counseling (family or individual)                                                              0
e. Anger Management                                                                               0
d. Other (Input total# others)                                                                    0
(Please Specify)


                             TOTAL:               0          0          0             0           0
        Parenting Coordination
# Individuals    Referred
                  Ordered                                                                         0
# Individuals who Completed                                                                       0
           Parenting Classes
 # Individuals    Referred
                  Ordered                                                                         0
# Individuals who Completed                                                                       0
           Substance Abuse
 # Individuals    Referred
                   Ordered                                                                        0
a. Screening                                                                                      0
b. Evaluation                                                                                     0
c. Treatment                                                                                      0
     TOTAL REFERRALS/ORDERS (a., b., c.):         0          0          0             0           0
             Other Services:
a.                                                                                                0
b.                                                                                                0
c.                                                                                                0
d.                                                                                                0
                                TOTAL:            0         0           0             0           0
                                            Co-Parenting Education
# Individuals     Referred
                  Ordered                                                                         0
# Individual who Completed Class                                                                  0
       Demographics                   *Leave this section blank if printed report is attached.*
Ethnic Background
African American/Black                                                                            0
Asian                                                                                             0
Caucasian/White                                                                                   0
                                                                                                            Jurisdiction
                                                                                                             does not
                                                                                                            collect this
                                              1st Qtr       2nd Qtr   3rd Qtr       4th Qtr       YTD           info
Hispanic                                                                                                0
More than one race/Biracial                                                                             0
Native American                                                                                         0
Pacific Islander                                                                                        0
Other: (Input total # of "others")                                                                      0
Please Specify:


                                     TOTAL:             0         0             0             0         0
Gender
Male                                                                                                    0
Female                                                                                                  0
                                     TOTAL:             0         0             0             0         0
Household Income
$0-$14,99                                                                                               0
$15,000 - $29,999                                                                                       0
$30,000 - $49,999                                                                                       0
$50,000 - $69,999                                                                                       0
$70,000 - $99,999                                                                                       0
$100,000 +                                                                                              0
No Response/Refused                                                                                     0
                                     TOTAL:             0         0             0             0         0
Education
Less than High School                                                                                   0
High School                                                                                             0
Technical School                                                                                        0
Some College Classes                                                                                    0
Associates Degree                                                                                       0
Bachelors Degree                                                                                        0
Advanced Degree                                                                                         0
No Response/Refused                                                                                     0
                                     TOTAL:             0         0             0             0         0
Marital Status
Married to Co-Parent                                                                                    0
Divorced from Co-Parent                                                                                 0
Never Married to Co-Parent                                                                              0
No Response/Refused                                                                                     0
                                     TOTAL:             0         0             0             0         0
Major Language Spoken
English                                                                                                 0
Spanish                                                                                                 0
Other: (Input total # of "others")                                                                      0
Please Specify:


No Response/Refused                                                                                     0
                        TOTAL:                          0         0             0             0         0
Other Courses Recommended
                                                                                                              Jurisdiction
                                                                                                               does not
                                                                                                              collect this
                                               1st Qtr       2nd Qtr    3rd Qtr       4th Qtr       YTD           info
Being an Effective Step-Parent                                                                            0
Co-Parenting for Never Married Couples                                                                    0
Relative Care Providers                                                                                   0
For Kids: An Education Prgrm for Kids
Experiencing Divorce or Separation                                                                        0
Other: (Input total # of "others")                                                                        0
Please Specify:


                                     TOTAL:           0          0                0             0         0
                                                   Self-Help Center
# Served                                                                                                  0
             Demographics                     *Leave this section blank if printed report is attached.*
Ethnic Background
African American/Black                                                                                    0
Asian                                                                                                     0
Caucasian/White                                                                                           0
Hispanic                                                                                                  0
More than one race/Biracial                                                                               0
Native American                                                                                           0
Pacific Islander                                                                                          0
Other: (Input total # of "others")                                                                        0
Please Specify:


                                     TOTAL:              0          0             0             0         0
Gender
Male                                                                                                      0
Female                                                                                                    0
                                     TOTAL:              0          0             0             0         0
Household Income
$0-$14,999                                                                                                0
$15,000 - $29,999                                                                                         0
$30,000 - $49,999                                                                                         0
$50,000 - $69,999                                                                                         0
$70,000 - $99,999                                                                                         0
$100,000 +                                                                                                0
No Response/Refused                                                                                       0
                                     TOTAL:              0          0             0             0         0
Education
Less than High School                                                                                     0
High School                                                                                               0
Technical School                                                                                          0
Some College                                                                                              0
Associates Degree                                                                                         0
Bachelors Degree                                                                                          0
Advanced Degree                                                                                           0
No Response/Refused                                                                                       0
                                                                                                               Jurisdiction
                                                                                                                does not
                                                                                                               collect this
                                               1st Qtr       2nd Qtr    3rd Qtr       4th Qtr       YTD            info
                                     TOTAL:              0          0             0             0         0
Major Language Spoken
English                                                                                                   0
Spanish                                                                                                   0
Other: (Input total # of "others")                                                                        0
Please Specify:


No Response/Refused                                                                                       0
                                     TOTAL:              0          0             0             0         0
Type of Assistance Provided
Telephone Assistance                                     5          5             5             5         20
Walk-In Assistance                                                                                         0
a. Forms Only                                                                                              0
b. Legal Advice                                                                                            0
b. Mediation Preparation                                                                                   0
c. Parenting Plan Review                                                                                   0
e. Trial Preparation                                                                                       0
              TOTAL (phone & walk-in) :                                                                    0
Assistance by Case Type
Absolute Divorce                                                                                          0
Adoption                                                                                                  0
Alimony                                                                                                   0
Child Support IV-D                                                                                        0
Child Support non IV-D                                                                                    0
Custody                                                                                                   0
Domestic Violence                                                                                         0
Guardianship                                                                                              0
Name Change                                                                                               0
Paternity                                                                                                 0
Visitation                                                                                                0
                                  TOTAL:                 0          0             0             0         0
Further Assistance Recommended
Child Support Agency                                                                                      0
Lawyer Referral (e.g.Bar Assoc or Other                                                                   0
Private Atty Referral Prgrm)                                                                              0
Legal Services Provider (e.g. Legal Aid)                                                                  0
Proceed Pro Se                                                                                            0
Other: (Input total # of "others")                                                                        0
Please Specify:


                                     TOTAL:           0           0               0             0         0
                                                   Pro Se Statistics
# Cases Involving Child Access Issues                                                                     0
Domestic Cases                                *Leave this section blank if printed report is attached.*
a. # no Pro Se parties at answer                                                                          0
b. # 1 Pro Se party at answer                                                                             0
                                                                                                               Jurisdiction
                                                                                                                does not
                                                                                                               collect this
                                                             1st Qtr   2nd Qtr   3rd Qtr   4th Qtr   YTD           info
c. # 2 or more Pro Se parties at answer                                                                    0
d. # no Pro Se parties at scheduling conference                                                            0
e. # 1 Pro Se party at scheduling conference                                                               0
f. # 2 or more Pro Se parties at scheduling conference                                                     0
g. # no Pro Se parties at pendente lite hearing                                                            0
h. # 1 Pro Se party at pendente lite hearing                                                               0
i. # 2 or more Pro Se parties at pendente lite hearing                                                     0
j. # no Pro Se parties at contempt hearing                                                                 0
k. # 1 Pro Se party at contempt hearing                                                                    0
l. # 2 or more Pro Se parties at contempt hearing                                                          0
m. # no Pro Se parties at settlement conference                                                            0
n. # 1 Pro Se party at settlement conference                                                               0
o. # 2 or more Pro Se parties at settlement conference                                                     0
p. # no Pro Se parties at pretrial hearing                                                                 0
q. # 1 Pro Se party at pretrial hearing                                                                    0
r.# 2 or more Pro Se parties at pretrial hearing                                                           0
s.# no Pro Se parties at uncontested hearing                                                               0
t.# 1 Pro Se party at uncontested hearing                                                                  0
u.# 2 or more Pro Se parties at uncontested hearing                                                        0
v. # no Pro Se parties at trial                                                                            0
w. # 1 Pro Se party at trial                                                                               0
x. # 2 or more Pro Se parties at trial                                                                     0
y. # no Pro Se parties at disposition                                                                      0
z. # 1 Pro Se party at disposition                                                                         0
aa. # 2 or more Pro Se parties at disposition                                                              0
CINA/TPR Cases
a. # no Pro Se parties at shelter hearing                                                                  0
b. # 1 Pro Se party at shelter hearing                                                                     0
c. # 2 or more Pro Se parties at shelter hearing                                                           0
d. # no Pro Se parties at adjudication hearing                                                             0
e. # 1 Pro Se party at adjudication hearing                                                                0
f. # 2 or more Pro Se parties at adjudication hearing                                                      0
g. # no Pro Se parties at disposition hearing                                                              0
h. # 1 Pro Se party at disposition hearing                                                                 0
i. # 2 or more Pro Se parties at disposition hearing                                                       0
j. # no Pro Se parties at initial permanency hearing                                                       0
k. # 1 Pro Se party at initial permanency hearing                                                          0
l.# 2 or more Pro Se parties at initial permanency hearing                                                 0
m. # no Pro Se parties at settlement conference                                                            0
n. # 1 Pro Se party at settlement conference                                                               0
o. # 2 or more Pro Se parties at settlement conference                                                     0
p. # no Pro Se parties at permanency/review                                                                0
q. # 1 Pro Se party at permanency/review hearing                                                           0
r. # 2 or more Pro Se parties at permanency/review                                                         0
s. # no Pro Se parties at TPR hearing/trial                                                                0
                                                                                                        Jurisdiction
                                                                                                         does not
                                                                                                        collect this
                                                      1st Qtr   2nd Qtr   3rd Qtr   4th Qtr   YTD           info
t. # 1 Pro Se party at TPR hearing/trial                                                            0
u. # 2 or more Pro Se parties at TPR hearing/trial                                                  0
v. # no Pro Se parties at guardianship review                                                       0
w.# 1 Pro Se party at guardianship review                                                           0
x.# 2 or more Pro Se parties at guardianship review                                                 0
                           GUIDE TO JURISDICTIONAL REPORT
                                               ADR Programs
Domestic Violence Screening
Please list (by role) those who are In this box, please list the positions/role of those responsible for
responsible for screening for DV    screening cases for signs of domestic violence. (e.g. Masters, Clerks,
→                                   Judges)
                                    In-person + Not In-person should will not necessarily = # Cases
# Cases Screened
                                    Screened. Some cases may be screened on the papers and in-person.
           In-person
                                    Track by case, not by individual pleadings screened.
           Not in-person
      Mediation Programs            Mediation to address disputes involving the children, including but not
                                    limited to: legal and/or physical custody, visitation (“access”) to the
Custody/Visitation (non-CINA)       child(ren), school issues, etc. Rule 9-205
# Cases    Referred or   Ordered    For each time you see a check box with "referred or ordered," please check the one that
                                    applies in your jurisdiction.
# Held
 # Agreements Reached               This is the total of full & partial.
          Full Agreements:          If your program does not break # Agreements down into full/partial,
          Partial Agreements:       check "does not track"
                                    Mediation to address disputes involving financial issues, including but
Property/Financial                  not limited to: support (child and/or spousal), division of property, tax
                                    issues, etc.
# Cases    Referred or   Ordered                                                               0
# Held                                                                                         0
 # Agreements Reached               This is the total of full & partial.
          Full Agreements:          If your program does not break # Agreements down into full/partial,
          Partial Agreements:       check "does not track"
                                    Mediation to address issues that arise in a CINA or TPR matter. This
                                    can include, but is not limited to: change in permanency plan,
CINA/TPR
                                    communication between family, children, professionals, post-adoption
                                    contact, etc.
# Cases    Referred or   Ordered                                                               0
# Held
 # Agreements Reached               This is the total of full & partial.
          Full Agreements:          If your program does not break # Agreements down into full/partial,
          Partial Agreements:       check "does not track"
                                    A form of alternative dispute resolution in which parties (pro se or
                                    represented) are referred to a neutral facilitator to work-out an
                                    agreement on some or all of their issues, or fine-tune an agreement.
                                    These referrals are mostly commonly made on the day of the Scheduling
Facilitator Program                 Conference or Hearing on the Merits. Any agreements are put on the
                                    record that day. Jurisdictions report that use these programs report
                                    fewer modifications to agreements and parties with a better
                                    understanding of the law and their legal options.

# Cases    Referred or   Ordered                                                                       0
# Held
 # Agreements Reached               This is the total of full & partial.
          Full Agreements:          If your program does not break # Agreements down into full/partial,
          Partial Agreements:       check "does not track"
                                             Meetings between the parties (and counsel) conducted by Judges or
Settlement Conference                        Masters or another neutral third party held prior to a hearing on the
                                             merits. Also known as "pre-trial conference."
 # Cases Referred                                                                                     0
# Held
 # Agreements Reached                                                                            0
          Full Agreements:                   If your program does not break # Agreements down into full/partial,
          Partial Agreements:                check "does not track"
     Scheduling Conference
# Cases        Referred or     Ordered                                                                    0
# Held                                                                                                    0
                   Other:
a.                                                                                                        0
b.                                                                                                        0
c.                                                                                                        0
d.                                                                                                        0
                                               Other Family Court Services
 Children's Attorney (Non-CINA)              Report only those funded through the Jurisdictional budget.
     # of Attys appointed in each category
a. Best Interest Attorney                                                                                 0
b. Child Advocate                                                                                         0
c. Child's Privilege Attorney                                                                             0
   TOTAL # Attorneys Appointed                                                                            0
       Children's Programs
a. Psycho-Educational          Count by # of Children, not by case.
b. Childcare/Waiting Room      Count by # of Children, not by case.
                                             Often ordered in contested custody and visitation cases to help the judge
                                             understand what parenting arrangement is in the best interest of the children.
Child Custody Related                        This investigation may include, but is not limited to: interviews with caretakers
Evaluations or Investigations                and children, a home study, contacts with collaterals such as teachers, mental
                                             health evaluations, etc. Other terms used: Child Custody Evaluation, Visitation
                                             Investigation.

# Ordered
# Complete (Counted by Case)                                                                          0
                                             A visit to a caretaker’s residence to determine the safety and
                                             appropriateness of the home. *A home visit conducted as part of a
Home Visits
                                             larger custody investigation/evaluation should not be counted as a
                                             separate home visit in this category.
# Ordered
                                                 Counted by # of cases, not by homes.
# Complete (Counted by Case)                                                                              0
       Visitation Services
Visitation
a. # Cases Referred                                                                                       0
b. # Cases Retained from Prior Qtr                                                                        0
c. # Supervised Visits Held                                                                               0
d. # Supervised Hours                                                                                     0
e. # Parents Utilizing Program                                                                            0
f. # Grandparents Utilizing Program                                                                       0
g. # Children Utilizing Program                                                                           0
                                           Cases that are “closed successfully” are those that no longer need the
                                           services of the visitation center in which the intention is visits to continue
                                           outside of the center. These include, but are not limited to: cases in
                                           which a Protective Order is no longer in effect, the supervised party
                                           completed court ordered services successfully, parties have developed
h. # Cases Closed Successfully
                                           an alternative arrangement for visitation by agreement or order
                                           (including use of a relative or friend as a supervisor), etc. These do not
                                           include cases in which the court ordered the termination of one or both
                                           parties’ visitation with the child(ren).

                                           Cases that are “closed unsuccessfully” are those that are no longer
                                           using the services of the center with no plan to continue visitation
i. # Cases Closed Unsuccessfully           outside of the center. These cases include, but are not limited to, those
                                           that have closed due to non-compliance and those in which the court
                                           has terminated visitation altogether.
j. Cases Converted to Monitored Exchange

Monitored Exchange
a. # Actual Exchanges                                                                        0
b. # Parents Utilizing Program                                                               0
c. # Grandparents Utilizing Program                                                          0
d. # Children Utilizing Program                                                              0
e. # Cases Closed Successfully        See above definitions for successful/unsuccessful closure of visitation
f. # Cases Closed Unsuccessfully      cases.
Emergency Assistance/Crisis Intervention
# Requests for Emergency                                                                     0
                              # filed                                                        0
                                           Track number of requests for emergency hearings that were granted - to be tracked by
                          # granted hearing, not by specific relief granted.
Requests for Assistance (Domestic Relations ONLY) OPTIONAL
a. in person                                                                                                 0
b. by phone                                                                                                  0
                            TOTAL:              0              0             0                 0             0
      Mental Health Services
    Individuals Referred by Type
a. Psychological Evaluations                                                                                 0
b. Psychiatric Evaluations                                                                                   0
c. Counseling (family or individual)                                                                         0
e. Anger Management                                                                                          0
d. Other (Input total# others)                                                                               0
(Please Specify)
                                           Enter nothing in this area.

                                TOTAL:               0           0            0          0           0
                                           Parties are referred to a professional (often a legal or mental health
Parenting Coordination                     professional,) to assist the parties in making decisions regarding their
                                           children. Often used in high-conflict cases
# Individuals   Referred or    Ordered                                                               0
# Individuals who Completed                                                                          0
                                        Different from “Co-Parenting Education,” these are classes to which the
                                        court may refer parents that commonly address general parenting
                                        education issues including, but not limited to: child development,
Parenting Classes                       discipline, etc. Parents may also be referred to classes which address
                                        more narrow issues such as parenting teenagers. These classes are
                                        most commonly provided by an organization external to the court.

# Individuals   Referred or   Ordered                                                         0
# Individuals who Completed                                                                   0
         Substance Abuse

# Individuals   Referred or   Ordered
a. Screening                        Any screening for substance abuse, includes all types of testing.
b. Evaluation                       Also referred to as "Assessment."
c. Treatment                                                                                  0
      TOTAL REFERRALS (a., b., c.): a. + b. + c. ≠ Total Individuals Referred
           Other Services:
a.                                                                                            0
b.                                                                                            0
c.                                                                                            0
d.                                                                                            0
                             TOTAL:            0           0          0          0            0
                                           Co-Parenting Education
A six hour court-approved program for parents involved in child support, custody or visitation actions
designed to minimize the disruptive effects of separation and divorce on the lives of children. Parties are
ordered to this program at the discretion of the court. See Rule 9-204
# Individuals Referred or   Ordered                                                           0
# Individual who Completed Class                                                              0
        Demographics                   *Leave this section blank if printed report is attached.*
Ethnic Background
African American/Black                                                                        0
Asian                                                                                         0
Caucasion/White                                                                               0
Hispanic                                                                                      0
More than one race/Biracial                                                                   0
Native American                                                                               0
Pacific Islander                                                                              0
Other: (Input total # of "others")                                                            0
Please Specify: (ex. 2 - Pakistani,
1 - Trinidadian - Total would be 3) Enter nothing in this area.

                               TOTAL:            0          0           0          0          0

				
DOCUMENT INFO
Description: Maryland Pro Se Divorce Forms document sample