COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

APPLICATION FOR THE

GUARDIAN AD LITEM APPOINTMENT LIST

Pursuant to Domestic Relations Court Local Rule Title X, I hereby apply to be eligible for appointment as guardian ad litem for minor children in domestic relations cases involving the allocation of parental rights, custody, visitation and related issues.

Name:	Telephone:
Attorney No.	Cell Phone:
Business Address:	FAX:
Email:

This application must include:

(1) a resume stating the applicant’s training, foreign language proficiency, experience and expertise demonstrating the applicant’s ability to successfully perform the duties and the responsibilities of the guardian ad litem;

(2) a copy of the applicant’s certificate for completing the required 12 hours of pre-service training;

(3) a copy of the applicant’s criminal background check;

(4) the applicant’s original Background Disclosure Statement (Form DR 10.1A);

(5) a copy of applicant’s malpractice insurance.

Incomplete applications will not be accepted and will be returned.

I certify that the information herein is true and accurate to the best of my knowledge and belief. I certify that I have read and understand the duties and obligations of a guardian ad litem as set forth in the Local Rules of the Court.

Signature Date