Session Request Form

Please indicate which of the following is correct:
   I am requesting a PC Session, OR
   I already have a Session scheduled on (enter like MM/DD/YY).

If you believe this is an emergent issue, please email the forensic assistant to request a more immediate review to determine whether the issue is time sensitive.

Assigned Provider:

Please check each item below to indicate your understanding of and agreement with each. You will have the opportunity to upload documents at the end of the confirmation page.

I am providing no more than 2 agenda items to be considered for the meeting.

Each agenda item and requested action must be written in 3 short sentences or less. (Agenda requests are limited to the session request form and additional pages will not be accepted.)

I understand that if I put more than a single agenda item in the provided space, that only the first item I listed will be included in the session.

Before the session is conducted, my items will be reviewed to make sure they are appropriate topics.

I discussed issues that could be resolved through communication with the other parent and we were unable to come to an agreement. The Parenting Coordinator is not responsible for making sure such attempts were made.

My agenda items and supporting documentation must be submitted at least five (5) business days before my scheduled session to be included.

I understand that an agenda will be provided to me at least 48 hours prior to my scheduled session so that I am prepared to discuss the agenda items. If I have concerns about the agenda items I will address them with the assistant at least 24 hours prior to the session.

Each item should pertain to one of the following 3 issues:
    • a violation of the parenting plan
    • an unresolved legal decision (medical, education, religious or personal care)
    • an issue that involves the best interest of the child(ren)

I will only submit additional information that supports concerns identified in the agenda items. Note: You will have the opportunity to upload documents at the end of the confirmation page.

When submitting supporting documents, I will submit no more than 3 strings of pertinent email examples.

Agenda Item 1:

In the box below, write the unresolved issue in 3 short sentences or less:

Limit of 1000 characters - characters remaining:

Is it a violation of the parenting plan? Yes     No

Is it an unresolved joint legal custody decision? Yes     No

If yes to either of the above, quote the specific provision within a Court order that is being violated and the date the Court ordered it:
Date of the Court order:
Page # of the provision in the order:
Quoted Provision:

Limit of 1000 characters - characters remaining:

Identify the action you would like taken to resolve the issue:

Limit of 1000 characters - characters remaining:

Agenda Item 2:

In the box below, write the unresolved issue in 3 short sentences or less:

Limit of 1000 characters - characters remaining:

Is it a violation of the parenting plan? Yes     No

Is it an unresolved joint legal custody decision? Yes     No

If yes to either of the above, quote the specific provision within a Court order that is being violated and the date the Court ordered it:
Date of the Court order:
Page # of the provision in the order:
Quoted Provision:

Limit of 1000 characters - characters remaining:

Identify the action you would like taken to resolve the issue:

Limit of 1000 characters - characters remaining:

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