This form is for use ONLY by parents in cases filed the Department of Family and Protective Services (also known as CPS) in which CPS is seeking custody of one or more children. This form is NOT for use in cases where CPS is only seeking parents to complete services nor is it to be used in any private family law cases.
To request a court-appointed attorney, the CPS parent will need to complete the form in its entirety. Please be sure that your contact information is correct and legible as this is how the Court and your attorney, if appointed, will contact you. It is also important that you enter an answer in each line, even if the answer is “none” or “n/a”. If you have no expenses and/or income, please write in an explanation as to how you are living (e.g. living with mother, etc.). Your request may be delayed or rejected if the form is not completed correctly. Once completed and signed, please return the form via one of these methods: