Fillable Visitation Access Services App (Travis County Information Technology Services)

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Visitation Access Services App (Travis County Information Technology Services)

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TRAVIS COUNTY JUVENILE PROBATION
DOMESTIC RELATIONS OFFICE
1010 LAVACA STREET P.O. BOX 1495 AUSTIN, TEXAS 7876 PHONE: (512) 854-9696 FAX: (512) 854-9819
ESTELA P. MEDINA
Chief Juvenile Probation Officer
SCOT M. DOYAL
Director
FRIEND OF THE COURT
VISITATION AND ACCESS APPLICATION
1010 Lavaca Street, P.O. Box 1495
Austin, TX 78767
512-854-9696 / fax 512-854-9819
CRITERIA FOR ACCEPTANCE OF APPLICATION BY THE DRO
DOMESTIC RELATIONS OFFICE ATTORNEYS AND STAFF SERVE AS A
“FRIEND OF THE COURT” AND REPRESENT NEITHER THE APPLICANT
NOR THE RESPONDING PARTY.
Both parties have the right to hire an attorney to represent them in any court action that
may be taken by the Domestic Relations Office.
Any legal parent may apply for services as long as the following criteria are met:
1. The order at issue is a FINAL court order (this includes Divorce Decrees, Modification
Orders, Paternity Decrees or Orders Establishing the Parent-Child Relationship, and
Protective Orders) and was issued by a Travis County Court, or has already been
transferred to Travis County (if it was originally issued by a court outside of Travis
County);
2. No litigation may be pending;
3. At least one of the parties must live in Travis or contiguous counties; and
4. The applicant must have attended the Visitation Services Program Orientation.
To apply for services with the Access and Visitation Program, please complete this
application and return the application to DRO front desk along with a copy of each pertinent
court order. You will be notified in writing of DRO’s acceptance and/or rejection of your case
once the application has been reviewed and processed.
In order for us to process your application, we ask that you complete the ENTIRE application
and acquire and keep in your possession all required documents. If you do not know the
answer to a question, please write “N/A” or “I do not know”. WITHOUT THE REQUIRED
INFORMATION, WE WILL BE UNABLE TO PROCESS YOUR APPLICATION.
FOR DEPARTMENT USE ONLY
ENFORCEMENT SERVICES INTERVENTION SERVICES
2
NOTICE: If the respondent lives out of town, the applicant will be required to pay the costs
of serving the other parent (usually about $150.00, but it varies with location). If the
applicant lives out of town, and the case is set for court, he/she will be required to attend a
hearing or hearings in Travis County.
IMPORTANT INFORMATION
PLEASE READ BEFORE YOU PROCEED
The other party will be sent a letter informing them of your application with the Domestic
Relations Office. Both parties are required to participate in a Conflict Resolution Meeting
and Cooperative Parenting classes if applicable.
It is the policy of this office to attempt to resolve disputes involving no possession by
attempting to negotiate the terms of the court ordered visitation and that the parties attend
the cooperative parenting classes. Every reasonable effort will be made to resolve the
possession dispute WITHOUT court action.
If warranted, referral to monitored exchanges or supervised visitation may be
recommended. By applying for services through the Travis County Domestic Relations Office,
you are agreeing to participate in all activities recommended by the Travis County DRO staff.
If at any time you feel the only recourse is litigation you will need to consult and/or hire a
private attorney to file the appropriate legal documents with the court and represent you.
THE DRO DOES NOT TAKE CASES TO COURT FOR MODIFICATION OF COURT
ORDERS.
PRIVACY ACT NOTICE: Disclosure of your social security number, and the social security
numbers of your children, is required by Section 105.006, Texas Family Code. Failure to
disclose this information may result in the denial of legal services. The Legal Enforcement
Division will only use these social security numbers for the purpose of enforcing visitation
for you.
I certify that I have read, understood and agree to abide by the terms of the criteria for
acceptance of a case by the DRO.
______________________________________________
APPLICANT SIGNATURE
3
FRIEND OF THE COURT
ACCESS AND VISITATION
CASE HISTORY
NAME: ______________________________________________ CAUSE NUMBER: ______________________________________
COUNTY: ___________________________________________ DATE: ___________________________________________________
INFORMATION ABOUT YOUR CHILD(REN):
Name: ______________________________________________ Name: ______________________________________________
Date of Birth: ______________ Age: ______ Sex: ______ Date of Birth: ______________ Age: ______ Sex: ______
Name: ______________________________________________ Name: ______________________________________________
Date of Birth: ______________ Age: ______ Sex: ______ Date of Birth: ______________ Age: ______ Sex: ______
Name: ______________________________________________ Name: ______________________________________________
Date of Birth: ______________ Age: ______ Sex: ______ Date of Birth: ______________ Age: ______ Sex: ______
1. What problem(s) are you having with your court ordered visitation? ________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
2. Are you the Custodial Parent or Non-Custodial Parent?
3. Which children are involved in this case?________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
4. At the time that the children involved in this case were born you were:
Not married to the other parent Married to the parent
Separated from the other parent Divorced from the other parent
5. Do you have a final Travis County court order? Yes No If no, what County/State?
__________________________________________________________________________________________________________________
6. Is there pending litigation? Yes No
4
7. Do you have an attorney or agency helping you with your visitation case? Yes No
If yes, list the name of the attorney(s) or agency(s), address(es) and phone number(s):
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
8. What is your visitation schedule?
Standard - 1
st
3rd and 5
th
weekend starting at 6pm on Friday-6pm on Sunday
2
nd
and 4
th
weekend starting at 6:00 pm Friday through 6:00 pm on Sunday
Supervised visits
Other
I don’t know
9. Have you made any “out-of-court” agreements with the other parent in regard to visitation
with your child(ren)? Yes No
If yes, please explain: ______________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
10. Has the custodial parent given you a reason or excuse why visitation has been denied?
Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
11. How long ago since your last visit with your child(ren)?
1 month 1 year
3 month More than 1 year
6 months Never had any visits
12. Have the police been called during exchanges? Yes No
If yes, please explain: ____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
5
13. Has the other parent ever alleged he/she is afraid of you? Yes No
If yes, please explain: ____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
14. Has there ever been a physical altercation between you and the other parent?
Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
15. Is there now or has there ever been a Restraining Order, Protective Order or Trespass
Warrant in effect against you, the other parent, or anyone else in either household?
Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
16. Is there a Non-Disclosure in place? Yes No
17. Has there ever been any family violence? Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
18. Has Child Protective Services (CPS) ever contacted you or the other parent? Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
19. Have you ever been accused, charged or convicted of sexual assault, indecency, injury, or
endangerment of a child? Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
6
20. Has any law enforcement authority ever contacted you with regard to the child(ren)?
Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
21. Are you currently in a relationship/married? Yes No
22. Please list all individuals who live with you and identify their relationship?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
23. Has there ever been a physical altercation between you and your current partner or any of
their family members? Yes No
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
24. How does the other parent get along with your partner?
Ok Does not like my current partner
Likes my partner Does not want my partner around our child(ren)
Does not know my partner
25. How does your child(ren) get along with your partner?
Ok Does not know my partner NA
Likes my partner Does not want to be around my partner
Does not like my partner
26. Do you have other children? Yes No If Yes, how does your child(ren) get along with
these children?
Ok Does not know my children
Likes my child(ren) Does not want my children to be in our home
Does not like my child(ren)
27. Does your child(ren) have any special medical needs? Yes No I don’t know
If yes, please explain: _____________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
7
28. How do you communicate with the other parent about your children?
Please check all that apply:
We don’t communicate Through our child(ren)
By phone, mail or e-mail In person
Through family members, please list ____________________________________________________________
_________________________________________________________________________________________________________
Other, please explain:_____________________________________________________________________________
29. If the other parent is asked if you have ever had any issues with drugs and/or alcohol what
do you think they would say? ____________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
30. Please include any additional information you believe we should know:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
8
INFORMATION ABOUT YOU
Full legal name: _______________________________________________________________________________________________
Nick name(s) Alias(es)________________________________________________________________________________________
Home Address: ________________________________________________________________________________________________
Street Apt# City Zip
How long have you lived at your current address?
less than 6 months 1 year
6 months more than 1 year
Telephone Contact Numbers: ( ) ____________________ ( ) ____________________ ( ) ____________________
Cell Home Work
Date of Birth: ________________________________________ Social Security: XXX-XX-______________________
Driver’s License # / State: __________________________ Current Marital Status: _______________________
Email Address: ______________________________________
Other contact information: _______________________________________________________________________
Employer: ______________________________________________________________________________________________________
Address: ________________________________________________________________________________________________________
Phone: __________________________________________________________________________________________________________
Occupation: _______________________________ Work Hour Schedule: ___________________________________________
List any physical or mental impairments, medical problems, etc: ________________________________________
__________________________________________________________________________________________________________________
Have you ever been arrested? Yes No If yes, please explain. List all charges and date(s)
arrested ________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
9
Have you ever served jail or prison time? Yes No If yes, list all charges and date(s) of
incarceration and release _____________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Have you ever been on parole, probation or received deferred adjudication Yes No
If yes, please explain: __________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
Have you used or are you currently using illegal drugs? Yes No
If yes, please explain: _________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
10
Do you have any outstanding or previous warrants for your arrest? Yes No
Charge(s): _____________________________________________________________________________________________________
In what County/ State_________________________________________________________________________________________
Charge(s): _____________________________________________________________________________________________________
In what County/ State_________________________________________________________________________________________
Ethnicity: Income:
American Indian / Alaska Native Less than $10,000
Asian American / Pacific Islander $10,000 – 19,999
Black/ African American $20,000 – 29,999
Hispanic $30,000 – 39,999
Multi-Ethnic $40,000 – 49,999
White $50,000 and above
11
INFORMATION ABOUT THE OTHER PARENT
Full legal name: _______________________________________________________________________________________________
Nick name(s) Alias(es)________________________________________________________________________________________
Home Address: ________________________________________________________________________________________________
Street Apt# City Zip
How long have they lived at their current address?
less than 3 months 1 year
6 months more than 1 year
Telephone Contact Numbers: ( ) ____________________ ( ) ____________________ ( ) ____________________
Cell Home Work
Date of Birth: ________________________________________ Social Security: XXX-XX-______________________
Driver’s License # / State: __________________________ Current Marital Status: _______________________
Email Address: ______________________________________
Other contact information: _______________________________________________________________________
Employer: ______________________________________________________________________________________________________
Address:________________________________________________________________________________________________________
Phone:__________________________________________________________________________________________________________
Occupation: _______________________________ Work Hour Schedule: ___________________________________________
List any physical or mental impairments, medical problems, etc: ________________________________________
__________________________________________________________________________________________________________________
List identifying information for example: glasses, tattoos, scars, marks, etc: ____________________________
__________________________________________________________________________________________________________________
Automobile make, model and year: __________________________________________________________________________
Color, license plate #, other identifying information: ______________________________________________________
Additional information/locations where service may be attempted: _____________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
12
Provide any information about hangouts, whereabouts (friend’s, clubs, bars, gym, relative’s home:
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Do you have a photograph of the other parent? Yes No If yes, please enclose with the
application.
Is the other parent currently married? Yes No With whom: _______________________________________
Is the other parent currently relationship? Yes No With whom: ____________________________________
Please list all individuals who live with the other parent and identify their relationship?
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Have they ever been arrested? Yes No If yes, please explain. List all charges and date(s)
arrested ________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Have they ever served jail or prison time? Yes No If yes, list all charges and date(s) of
incarceration and release _____________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Have they ever been on parole, probation or received deferred adjudication Yes No
If yes, please explain: __________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
13
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
List offense: ____________________________________________________________________________________________
Terms of Probation / Parole: _________________________________________________________________________
Date completed: _______________________________________________________________________________________
Parole /Probation Officer Name, Address and Phone Number: ___________________________________
__________________________________________________________________________________________________________
Have they used or are they currently using illegal drugs? Yes No
If yes, please explain: _________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Do they have any outstanding or previous warrants for their arrest? Yes No
Charge(s): _____________________________________________________________________________________________________
In what County/ State_________________________________________________________________________________________
Charge(s): _____________________________________________________________________________________________________
In what County/ State_________________________________________________________________________________________
Ethnicity: Income:
American Indian / Alaska Native Less than $10,000
Asian American / Pacific Islander $10,000 – 19,999
Black/ African American $20,000 – 29,999
Hispanic $30,000 – 39,999
Multi-Ethnic $40,000 – 49,999
White $50,000 and above
14
I declare all the above information provided is true and correct. I am aware that should
there be any falsification or failure to fully disclose information requested, my application
may be rejected, or the Domestic Relations Office may close my case without further
explanation. I understand that it is at the sole discretion of the Domestic Relations Office to
accept or reject any application.
_______________________________________ _______________________________
Applicant Signature Date Signed
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Visitation Access Services App (Travis County Information Technology Services)

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Completed 22 July 2020

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