Applicant Information - DiFranza Law

Thank you in advance for filling out the form! If you have any questions about the form, please call us; otherwise, please complete as much of it as possible. Once you complete the form, send it to us at iva@difranzalaw.com.

PLEASE PROVIDE INFORMATION ON PERSON WANTING TO BECOME GUARDIAN (Petitioner)

Name

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Does the guardian have a different mailing address?

Yes
No

Mailing Address

Telephone

Email

Age AND Date of Birth

Relationship to proposed Ward

Is petitioner a U.S. citizen?

Yes
No

Employer Name and Address

Is petitioner currently serving as guardian for another ward?

Yes
No

Petitioner has a physical disability

Yes
No

Petitioner has been judicially determined to have committed abuse, abandonment, or neglect against a child as defined by Florida law

Yes
No

Petitioner has been the subject of a confirmed report of abuse, neglect, or exploitation that has been uncontested or upheld under Florida law

Yes
No

Petitioner is a judge

Yes
No

Petitioner provides substantial services in a business capacity to ward

Yes
No

Petitioner is in the employer of any person, agency, government, or corporation that provides service to the proposed ward in a professional or business capacity

Yes
No

Petitioner has been charged with, arrested for, or convicted of a felony

Yes
No

Petitioner has entered a plea of no contest or pled guilty to a felony

Yes
No

Petitioner has filed for bankruptcy in the past

Yes
No

Petitioner has received instruction and training regarding legal guardianship duties and responsibilities

Yes
No

Petitioner earned other degrees or certifications

Yes
No

Petitioner possesses special educational qualifications (financial, business, or nursing, otherwise) that qualify petitioner to be appointed as guardian

Yes
No

If you answered yes to any of the above, please provide details/explanation

Education Information

Highest level of education

SELECT ALL THAT APPLY

Petitioner is the parent and works closely with the person’s health care providers, teachers and/or school personnel.
Petitioner is a member of the Arc and works closely with the personnel involved in the person’s activities.
The person is in the Med Waiver program and the Petitioner works closely with the APD Support Coordinator.
Petitioner (or other) has signed the person up for the Med Waiver program and the person is on the waiting list
Petitioner regularly attends trainings provided by the Arc
Petitioner regularly attends educational events for caretakers or families with individuals with special needs, such as Family Care Council trainings, other
Petitioner is a joint account holder on the Ward's bank account, which has minimal funds

(city)

other

Other information:

Interested in resources for individuals with developmental disabilities? Here is a great resource!
https://www.arcjacksonville.org/wp-content/uploads/2020/06/The-Arc-Jacksonvilles-The-PATH_2020.pdf

Petitioner has an incapacity or illness, including substance abuse, which may render the petitioner incapable of discharging guardian or guardian advocate duties.

Yes
No