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Juvenile Delinquency Benchbook Forms

The following forms comply with provisions of Ind. Code ยง 31-37-6-6, 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: October 28, 2022

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

Detention and Custody

Form # Form Title Date Approved Date Revised
D-1.02 Written Promise for Appearance of Juvenile 08.08.2008 10.28.2022
D-1.03 Notice of Detention of Child 08.08.2008 10.28.2022
D-1.04 Notice of Detention Hearing 08.08.2008 10.28.2022
D-1.05 Affidavit in Support of Probable Cause 08.08.2008 10.28.2022
D-1.06 Written Findings, Recommendations and 48 Hour Order Regarding Probable Cause 08.08.2008 07.29.2022
D-1.07 Order on Detention Hearing 08.08.2008 02.05.2021
D-1.08 Petition for Detention Hearing 08.08.2008 07.29.2022
D-1.09 Writ of Attachment for Failure to Appear 08.08.2008 07.29.2022
D-1.10 Detention Report to Court Delinquent Children 08.08.2008 08.08.2008

Preliminary Inquiry

Form Title Date Approved Date Revised
Intake Information for a Delinquent Child and Prosecutor's Request for Preliminary Inquiry 08.08.2008 07.29.2022
Intake Officer's Advice to a Delinquent Child and Parent, Guardian or Custodian 08.08.2008 07.29.2022

Informal Adjustment

Form Title Date Approved Date Revised
Informal Adjustment Extension Request 08.08.2008 07.29.2022
Order Extending Informal Adjustment 08.23.2022 07.29.2022
Program of Informal Adjustment 08.08.2008 07.29.2022
Order on Informal Adjustment 08.23.2022 07.29.2022
Petition for Order of Compliance 08.08.2008 07.29.2022

Delinquency Petition

Form # Form Title Date Approved Date Revised
D-5.02 Request for Custody Order 08.08.2008 07.29.2022
D-5.03 Order Approving Filing of Delinquency Petition [including Status Delinquent] 08.08.2008 07.29.2022
D-5.05 Petition Alleging Delinquency 08.08.2008 08.08.2008
D-5.06 Order Setting Initial Hearing on Delinquency Petition and for Issuance of Summons 08.08.2008 02.09.2010
D-5.07 Summons 08.08.2008 08.08.2008

Initial Hearing

Form # Form Title Date Approved Date Revised
D-6.00 C.R. 25: Waiver of Attorney 11.20.2014 03.16.2015
D-6.02 Order on Appointment of Attorney 08.08.2008 08.08.2008
D-6.03 Order on Initial Hearing on Delinquency Petition Crime Delinquent (No Waiver Requested) 08.08.2008 02.05.2021
D-6.04 Order on Initial Hearing on Delinquency Petition Crime Delinquent (Waiver Requested) 08.08.2008 02.05.2021
D-6.05 Order on Initial Hearing on Status Delinquency Petition 08.08.2008 02.05.2021
D-6.06 Order on Initial Hearing on Delinquency Petition (Denial of Delinquency) 08.08.2008 02.05.2021
D-DISPO ALT Dispositional Alternatives (Indiana Code 31-37-19-5 & 31-37-19-6) 08.08.2008 08.08.2008

Waiver

Form Title Date Approved Date Revised
Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-2) 08.08.2008 07.29.2022
Waiver Order (Indiana Code 31-30-3-2) 08.08.2008 07.29.2022
Prosecutor's Motion for Waiver of Juvenile Jurisdiction on Controlled Substances Felony (Indiana Code 31-30-3-3) 08.08.2008 07.29.2022
Waiver Order (Indiana Code 31-30-3-3) 08.08.2008 07.29.2022
Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-4) 08.08.2008 07.29.2022
Waiver Order (Indiana Code 31-30-3-4) 08.08.2008 07.29.2022
Prosecutor's Motion for Waiver of Juvenile Jurisdiction (Indiana Code 31-30-3-5) 08.08.2008 07.29.2022
Waiver Order (Indiana Code 31-30-3-5) 08.08.2008 07.29.2022
Prosecutor's Motion for Presumptive Waiver of Juvenile Jurisdiction Over Child Previously Convicted of Felony or Non-Traffic Misdemeanor 08.08.2008 07.29.2022
Waiver Order (Indiana Code 31-30-3-6) 08.08.2008 07.29.2022
Order Denying Waiver 08.08.2008 07.29.2022

Factfinding

Form # Form Title Date Approved Date Revised
D-9.02 Order of Fact-Finding Hearing on Delinquency Petition (Finding Child is Delinquent Child) 08.08.2008 02.05.2021
D-9.03 Order on Fact-Finding Hearing on Delinquency Petition (Finding Child is not a Delinquent Child) 08.08.2008 10.28.2022

Dispositional Hearings

Form # Form Title Date Approved Date Revised
D-11.03 Dispositional Order 08.08.2008 07.30.2021
D-11.04 Dispositional Order - Wardship Awarded to Dept. of Correction 08.08.2008 07.29.2022
D-11.05 Order to Reinstate Jurisdiction Over Child 08.08.2008 11.26.2018
D-11.08 Financial Obligation Order 08.08.2008 11.26.2018

Parental Participation

Form # Form Title Date Approved Date Revised
D-12.02 Petition for Parental Participation 08.08.2008 10.28.2022
D-12.03 Order of Participation 08.08.2008 10.28.2022
D-12.04 Verified Information for Rule to Show Cause 08.08.2008 07.29.2022
D-12.05 Order to Show Cause 08.08.2008 07.29.2022
D-12.06 Motion for Release from Probation and Reimbursement of Costs 08.08.2008 07.29.2022
D-12.07 Order on Motion for Release from Probation and Reimbursement of Costs 08.08.2008 07.29.2022

Post-Disposition

Form # Form Title Date Approved Date Revised
D-14.02 Verified Petition for Modification of Dispositional Decree 08.08.2008 08.08.2008
D-14.03 Notice of Hearing on Periodic Review of (or Petition to Modify) Dispositional Order 08.08.2008 08.08.2008
D-14.04 Order for Hearing and Notice on Modification Petition Including Temporary Order 08.08.2008 02.09.2010
D-14.05 Order on Periodic [Six (6) Month] Review Hearing (Indiana Code 31-37-20-2) 08.08.2008 02.05.2021
D-14.05a Order on Periodic Case Review - APPLA 05.10.2016 02.05.2021
D-14.06a Order Approving Permanency Plan - Non-APPLA 05.10.2016 02.05.2021
D-14.06b Order Approving Permanency Plan - APPLA 05.10.2016 02.05.2021
D-14.07 Order on Modification Hearing 08.08.2008 07.29.2022
D-14.08 Modified Dispositional Order (Secure Placement) 08.08.2008 07.29.2022
D-14.09 Notice of Detention Hearing 08.08.2008 08.08.2008
D-14.10 Order for DCS Payment of Polygraph Examination 11.26.2018  

Public Access

Form # Form Title Date Approved Date Revised
D-15.02 Order Closing Public Access to Juvenile Proceeding During Testimony of Child Witness / Victim 08.08.2008 08.08.2008
D-15.03 Order Granting Access to Certain Juvenile Records 08.08.2008 08.08.2008

Miscellaneous Forms

Form # Form Title Date Approved Date Revised
D-16.01 Order of Pre-Adjudication Suspension of License (Indiana Code 31-37-5-7) 08.08.2008 08.08.2008
D-16.02 Order of Reinstatement of Driving Privileges (Indiana Code 31-37-5-7(b)) 08.08.2008 08.08.2008
D-16.04 Expungement Petition 02.25.2015 07.28.2017
D-16.05 Expungement Order 02.25.2015 05.26.2022
D-16.06 Dual Status Screening Tool Report 03.10.2016  
D-16.07 Referral to Dual Status Assessment Team 03.10.2016  
D-16.08 Recommendation of Dual Status Assessment Team 03.10.2016  
D-16.09Order on Recommendation of Dual Status Assessment Team 03.10.2016  
D-16.10 Emancipation Order 03.10.2016  
D.16.11 Order on Automatic Expungement (Granting) 03.25.2022 05.26.2022
D.16.12 Order on Automatic Expungement (Denying) 03.25.2022 05.26.2022

Indian Child Welfare Act

Form # Form Title Date Approved Date Revised
D-17.01 Indian Child Welfare Act Benchcard 05.01.2017  

Qualified Residential Treatment Program (QRTP)

Form Title Date Revised
Motion for Residential Placement and Motion to Set Hearing 01.28.2022
Order for Placement Pending Assessment & Order Setting 60 Day Review Hearing 10.01.2021
Order on 60 Day Review of Placement in QRTP 06.11.2021
Order on Subsequent Review of Placement in QRTP 06.11.2021

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