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IN THE COURT OF COMMON PLEAS, GREENE COUNTY, OHIO DOMESTIC RELATIONS DIVISION AND JUVENILE COURT HOMESTUDY QUESTIONNAIRE (On-Line Fill in Form)

  1. Greene County Family and Children First

    Disclaimer: Information submitted on this on-line form will be sent via email. If you would prefer to provide information in another form, please find on our website the PDF format of this Questionnaire.   You will need to print this Home Study Questionnaire out, fill it out completely and mail it to:   Greene County Family and Children First, Attention: Family Relations, 158 East Main Street, Xenia, Ohio 45385


  2. HOMESTUDY QUESTIONNAIRE

    Please complete this form in it's entirety and attach any supplemental documents before submitting. For questions, please contact Leslie Grayson or Rose Hoersting at: leslie.grayson@greenecountyohio.gov ;  rose.hoersting@greenecountyohio.gov ;  OR  (937) 562-5600.

  3. Do you have a Current Valid Driver's License?
  4. Addresses in the last five (5) years -- (Include shelter residences):
  5. Please list the following regarding all other adults who reside with you:
  6. Do you currently have a companion living with you?
  7. PERSONAL INFORMATION:
  8. Are you presently married?
  9. Does your present spouse or companion have children from a former marriage or relationship?
  10. Do you have children who are NOT at issue in this case OR who reside with others? If so, please list:
  11. EMPLOYMENT STATUS
  12. HAVE YOU EVER BEEN FIRED?
  13. INCOME:
  14. DO YOU PAY CHILD SUPPORT?
  15. ARE YOU CURRENT?
  16. EDUCATION:
  17. ARE YOU A HIGH SCHOOL GRADUATE?
  18. GED
  19. IN SCHOOL NOW?
  20. HEALTH & WELLNESS:
  21. Do you, or your spouse/companion, drink alcoholic beverages?
  22. HAVE YOU PARTICIPATED IN COUNSELING FOR ANY OF THE FOLLOWING?
  23. SUBSTANCE ABUSE
  24. ANGER MANAGEMENT
  25. MENTAL HEALTH
  26. PARENTING
  27. CRIMINAL HISTORY AND/OR SUPPORTIVE SERVICES HISTORY:
  28. ARE YOU CURRENTLY LISTED IN A CPO/TPO?
  29. HAVE YOU BEEN CONVICTED OF A CHILD-RELATED CRIME?
  30. HAVE YOU BEEN CONVICTED OF A CRIME RELATED TO DOMESTIC VIOLENCE?
  31. HAVE THE POLICE BEEN CALLED TO YOUR HOME FOR DOMESTIC PROBLEMS?
  32. HAVE YOU OR YOUR CHILDREN BEEN INVOLVED WITH CHILDREN SERVICES?
  33. ARE YOU CURRENTLY ON PROBATION?
  34. CHILDREN AT ISSUE:
  35. Leave This Blank:

  36. This field is not part of the form submission.