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Juvenile Delinquency Benchbook Forms

The following forms comply with provisions of HEA 1001, which requires that court orders include "language approved and recommended by the judicial conference of Indiana in relation to removal or detention."  Failure to adopt language from these forms, most significantly the federal IV-E language, may result in your county being liable for the costs of placement of a child.

Forms Last Updated or Newly Approved: February 5, 2021

The forms below are available in Microsoft Word format. To view and print Word documents, you must have Microsoft Word installed on your computer.

Access Probation Officers' Reports on the Probation Website

Chapter 1. Detention and Custody

Form #Form TitleDate ApprovedDate Revised
D-1.02Written Promise for Appearance of Juvenile08.08.200808.08.2008
D-1.03Notice of Detention of Child08.08.200808.08.2008
D-1.04Notice of Detention Hearing08.08.200808.08.2008
D-1.05Affidavit in Support of Probable Cause08.08.200808.08.2008
D-1.06Written Findings, Recommendations and 48 Hour Order Regarding Probable Cause08.08.200802.09.2010
D-1.07Order on Detention Hearing08.08.200802.05.2021
D-1.08Petition for Detention Hearing08.08.200808.08.2008
D-1.09Writ of Attachment for Failure to Appear08.08.200808.08.2008
D-1.10Detention Report to Court Delinquent Children08.08.200808.08.2008

Chapter 3. Preliminary Inquiry

Form #Form TitleDate ApprovedDate Revised
D-3.02Intake Information for a Delinquent Child and Prosecutor's Request for Preliminary Inquiry08.08.200808.08.2008
D-3.03Intake Officer's Advice to a Delinquent Child and Parent, Guardian or Custodian08.08.200808.08.2008
D-3.04Consent to Background Investigation and Release08.08.200808.08.2008

Chapter 4. Informal Adjustment

Form #Form TitleDate ApprovedDate Revised
D-4. IA EXTInformal Adjustment Extension Request08.08.200808.08.2008
D-4.03Program of Informal Adjustment08.08.200808.08.2008
D-4.04Petition for Order of Compliance08.08.200808.08.2008

Chapter 5. Delinquency Petition

Form #Form TitleDate ApprovedDate Revised
D-5.02Request for Custody Order08.08.200808.08.2008
D-5.03Order Approving Filing of Delinquency Petition Crime Delinquent08.08.200811.03.2009
D-5.04Order Approving Filing of Delinquency Petition Status Delinquent08.08.200811.03.2009
D-5.05Petition Alleging Delinquency08.08.200808.08.2008
D-5.06Order Setting Initial Hearing on Delinquency Petition and for Issuance of Summons08.08.200802.09.2010
D-5.07Summons08.08.200808.08.2008

Chapter 6. Initial Hearing

Form #Form TitleDate ApprovedDate Revised
D-6.00C.R. 25: Waiver of Attorney11.20.201403.16.2015
D-6.02Order on Appointment of Attorney08.08.200808.08.2008
D-6.03Order on Initial Hearing on Delinquency Petition Crime Delinquent (No Waiver Requested)08.08.200802.05.2021
D-6.04Order on Initial Hearing on Delinquency Petition Crime Delinquent (Waiver Requested)08.08.200802.05.2021
D-6.05Order on Initial Hearing on Status Delinquency Petition08.08.200802.05.2021
D-6.06Order on Initial Hearing on Delinquency Petition (Denial or Delinquency)08.08.200802.05.2021
D-DISPO ALTDispositional Alternatives (Indiana Code 31-37-19-5 & 31-37-19-6)08.08.200808.08.2008

Chapter 7. Waiver

Form #Form TitleDate ApprovedDate Revised
D-7.02Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-2)08.08.200801.30.2017
D-7.03Waiver Order (Indiana Code 31-30-3-2)08.08.200801.30.2017
D-7.04Prosecutor's Motion for Waiver of Juvenile Jurisdiction on Controlled Substances Felony (Indiana Code 31-30-3-3)08.08.200801.30.2017
D-7.05Waiver Order (Indiana Code 31-30-3-3)08.08.200801.30.2017
D-7.06Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-4)08.08.200801.30.2017
D-7.07Waiver Order (Indiana Code 31-30-3-4)08.08.200801.30.2017
D-7.08Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-5)08.08.200801.30.2017
D-7.09Waiver Order (Indiana Code 31-30-3-5)08.08.200801.30.2017
D-7.10Prosecutor's Motion for Presumptive Waiver of Juvenile Jurisdiction Over Child Previously Convicted of Felony or Non-Traffic Misdemeanor08.08.200808.08.2008
D-7.11Waiver Order (Indiana Code 31-30-3-6)08.08.200808.08.2008
D-7.12Order Denying Waiver08.08.200808.08.2008

Chapter 9. Factfinding

Form #Form TitleDate ApprovedDate Revised
D-9.02Order of Fact-Finding Hearing on Delinquency Petition08.08.200802.05.2021
D-9.03Order on Fact-Finding Hearing on Delinquency Petition08.08.200808.08.2008

Chapter 11. Dispositional Hearings

Form #Form TitleDate ApprovedDate Revised
D-11.03Dispositional Order08.08.200802.05.2021
D-11.04Dispositional Order - Wardship Awarded to Dept. of Correction08.08.200811.26.2018
D-11.05Order to Reinstate Jurisdiction Over Child08.08.200811.26.2018
D-11.08Financial Obligation Order08.08.200811.26.2018

Chapter 12. Parental Participation

Form #Form TitleDate ApprovedDate Revised
D-12.02Petition for Parental Participation08.08.200808.08.2008
D-12.03Order of Participation08.08.200808.08.2008
D-12.04Verified Information for Rule to Show Cause08.08.200808.08.2008
D-12.05Order to Show Cause08.08.200808.08.2008
D-12.06Motion for Termination of Probation and Reimbursement of Costs08.08.200808.08.2008
D-12.07Order on Motion for Termination of Probation and Reimbursement of Costs08.08.200808.08.2008

Chapter 14. Post-Disposition

Form #Form TitleDate ApprovedDate Revised
D-14.02Verified Petition for Modification of Dispositional Decree08.08.200808.08.2008
D-14.03Notice of Hearing on Periodic Review of (or Petition to Modify) Dispositional Order08.08.200808.08.2008
D-14.04Order for Hearing and Notice on Modification Petition Including Temporary Order08.08.200802.09.2010
D-14.05Order on Periodic [Six (6) Month] Review Hearing (Indiana Code 31-37-20-2)08.08.200802.05.2021
D-14.05aOrder on Periodic Case Review - APPLA05.10.201602.05.2021
D-14.06aOrder Approving Permanency Plan - Non-APPLA05.10.201602.05.2021
D-14.06bOrder Approving Permanency Plan - APPLA05.10.201602.05.2021
D-14.07Order on Modification Hearing08.08.200802.05.2021
D-14.08Modified Dispositional Order (Secure Placement)08.08.200801.24.2020
D-14.09Notice of Detention Hearing08.08.200808.08.2008
D-14.10Order for DCS Payment of Polygraph Examination11.26.2018 

Chapter 15. Public Access

Form #Form TitleDate ApprovedDate Revised
D-15.02Order Closing Public Access to Juvenile Proceeding During Testimony of Child Witness / Victim08.08.200808.08.2008
D-15.03Order Granting Access to Certain Juvenile Records08.08.200808.08.2008

Chapter 16. Miscellaneous Forms

Form #Form TitleDate ApprovedDate Revised
D-16.01Order of Pre-Adjudication Suspension of License (Indiana Code 31-37-5-7)08.08.200808.08.2008
D-16.02Order of Reinstatement of Driving Privileges (Indiana Code 31-37-5-7(b))08.08.200808.08.2008
D-16.04Expungement Petition02.25.201507.28.2017
D-16.05Expungement Order02.25.201507.28.2017
D-16.06Dual Status Screening Tool Report03.10.2016 
D-16.07Referral to Dual Status Assessment Team03.10.2016 
D-16.08Recommendation of Dual Status Assessment Team03.10.2016 
D-16.09Order on Recommendation of Dual Status Assessment Team03.10.2016 
D-16.10Emancipation Order03.10.2016 

Chapter 17: Indian Child Welfare Act

Form #Form TitleDate ApprovedDate Revised
D-17.01Indian Child Welfare Act Benchcard05.01,2017 

Qualified Residential Treatment Program (QRTP)

Form TitleDate Revised
Motion for Residential Placement and Motion to Set Hearing03.12.2021
Order for Placement Pending Assessment & Order Setting 60 Day Review Hearing03.12.2021
Order on 60 Day Review of Placement in QRTP03.12.2021
Order on Subsequent Review of Placement in QRTP03.12.2021