Guardianship Petition

IMPORTANT: THIS IS A PREPARATION GUIDE — NOT THE OFFICIAL COURT FORM

District of Columbia courts require the use of official court-approved forms for guardianship petitions,
filed in the Probate Division of the DC Superior Court.
This template provides the substantive legal content to help you prepare — but you must
transfer your content to the official form required by your local court before filing.
Contact your county clerk's office or visit https://www.dccourts.gov/services/forms for the required forms.
Do not file this document directly with the court.

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA

Probate Division

IN THE MATTER OF:

PETITION FOR APPOINTMENT OF GUARDIAN

Type of Guardianship Requested

☐ General Guardian of the Person
☐ Limited Guardian of the Person
☐ Temporary Guardian (Emergency — up to 21 days, per D.C. Code § 21-2046)
☐ Temporary Guardian (Health-Care — up to 90 days, per D.C. Code § 21-2046)
☐ Provisional Guardian (up to 6 months, per D.C. Code § 21-2046)
☐ Guardian of Minor (per D.C. Code Title 21, Chapter 1)
☐ Guardian and Conservator (combined petition)

I. PETITIONER INFORMATION

1. Full Legal Name of Petitioner: [________________________________]

2. Address: [________________________________]

City: [________________________________] State: [____] ZIP: [________________________________]

3. Telephone: [________________________________] Email: [________________________________]

4. Relationship to the Subject of Petition: [________________________________]

5. Interest of the Petitioner in this matter (per D.C. Code § 21-2041(a)):

☐ Spouse or domestic partner of the Subject
☐ Adult child of the Subject
☐ Parent of the Subject
☐ Adult sibling of the Subject
☐ Other relative — specify: [________________________________]
☐ Person with whom the Subject resides
☐ Current caregiver or care facility representative
☐ Government agency or official
☐ Other interested person — specify: [________________________________]

6. Is Petitioner represented by counsel?

☐ Yes — Attorney Name: [________________________________]
Bar Number: [________________________________]
Firm: [________________________________]
Address: [________________________________]
Telephone: [________________________________] Email: [________________________________]

☐ No — Petitioner appears pro se

II. SUBJECT OF PETITION (ALLEGED INCAPACITATED INDIVIDUAL)

7. Full Legal Name: [________________________________]

8. Date of Birth: [__/__/____] Age: [____]

9. Current Residence Address: [________________________________]

City: [________________________________] State: [____] ZIP: [________________________________]

10. Type of Current Residence:

☐ Private home or apartment
☐ Assisted living facility
☐ Nursing home or skilled nursing facility
☐ Hospital
☐ Group home
☐ Homeless / no fixed address
☐ Other — specify: [________________________________]

11. Name and Address of Current Caregiver or Facility (if applicable):

[________________________________]

12. Primary Language Spoken: [________________________________]

☐ Interpreter required ☐ Interpreter not required

13. Is the Subject a citizen or resident of the District of Columbia?

☐ Yes — domiciled in D.C.
☐ Yes — physically present in D.C. (domiciled elsewhere)
☐ Subject owns property in D.C. (for protective order only)

PRACTICE NOTE: Under D.C. Code § 21-2041, any incapacitated individual present in D.C. or who is domiciled in D.C. may be the subject of a guardianship petition filed in D.C. Superior Court, Probate Division.

III. JURISDICTION AND VENUE

14. This Court has subject-matter jurisdiction over this proceeding pursuant to D.C. Code § 11-921(a)(5), which grants the Superior Court of the District of Columbia jurisdiction over guardianship and protective proceedings, and pursuant to D.C. Code § 21-2001 et seq.

15. Venue is proper in the District of Columbia because the Subject:

☐ Is domiciled in the District of Columbia
☐ Is physically present in the District of Columbia
☐ Owns property within the District of Columbia

IV. GROUNDS FOR GUARDIANSHIP — ALLEGATIONS OF INCAPACITY

Statutory Standard (D.C. Code § 21-2011(11)): An "incapacitated individual" means an adult whose ability to receive and evaluate information effectively or to communicate decisions is impaired to such an extent that he or she lacks the capacity to manage all or some of his or her financial resources or to meet all or some essential requirements for his or her physical health, safety, habilitation, or therapeutic needs without court-ordered assistance or the appointment of a guardian or conservator.

16. The Subject is alleged to be incapacitated due to the following conditions (check all that apply):

☐ Cognitive impairment or dementia
☐ Traumatic brain injury
☐ Mental illness or psychiatric condition
☐ Intellectual or developmental disability
☐ Substance use disorder
☐ Degenerative neurological condition
☐ Physical disability affecting ability to communicate decisions
☐ Age-related decline
☐ Other — specify: [________________________________]

17. Description of the Subject's functional limitations and specific areas of incapacity (state with "specific particularity" as required by D.C. Code § 21-2041(a)):

[________________________________]

[________________________________]

[________________________________]

[________________________________]

18. The Subject's incapacity affects his or her ability to (check all that apply):

☐ Make informed decisions about personal health care
☐ Make informed decisions about residential placement
☐ Manage activities of daily living (bathing, dressing, feeding, mobility)
☐ Protect himself or herself from abuse, neglect, or exploitation
☐ Manage financial resources and obligations
☐ Communicate decisions effectively
☐ Understand and evaluate information needed for decision-making
☐ Other — specify: [________________________________]

19. Known medical diagnoses relevant to incapacity:

[________________________________]

[________________________________]

20. Name and credentials of physician, psychologist, or other qualified professional who has evaluated the Subject:

Name: [________________________________]
Credentials / Title: [________________________________]
Date of Evaluation: [__/__/____]
Evaluation Report: ☐ Attached as Exhibit A ☐ To be provided prior to hearing

PRACTICE NOTE: Under D.C. Code § 21-2041, the court will appoint a qualified examiner to submit a written report. However, attaching medical evidence to the petition strengthens the filing. The petitioner bears the burden of proving incapacity by clear and convincing evidence.

V. LESS-RESTRICTIVE ALTERNATIVES

21. The following less-restrictive alternatives have been considered and are inadequate, unavailable, or inappropriate for the Subject (check all that apply and explain):

☐ Durable Power of Attorney — Reason insufficient: [________________________________]

☐ Health Care Power of Attorney / Advance Directive — Reason insufficient: [________________________________]

☐ Supported Decision-Making Agreement — Reason insufficient: [________________________________]

☐ Representative Payee — Reason insufficient: [________________________________]

☐ Voluntary admission to care facility — Reason insufficient: [________________________________]

☐ Community-based services and supports — Reason insufficient: [________________________________]

☐ Other alternatives considered: [________________________________]

PRACTICE NOTE: Under D.C. Code § 21-2044(a), the court must appoint the least restrictive form of guardianship. Demonstrating that less-restrictive alternatives have been explored and are insufficient is essential.

VI. PROPOSED GUARDIAN

22. Name of Proposed Guardian: [________________________________]

23. Date of Birth: [__/__/____] Age: [____]

24. Address: [________________________________]

City: [________________________________] State: [____] ZIP: [________________________________]

25. Telephone: [________________________________] Email: [________________________________]

26. Relationship to Subject: [________________________________]

27. Occupation: [________________________________]

28. Priority of Appointment (per D.C. Code § 21-2043):

☐ Person nominated by the Subject (current or prior designation)
☐ Spouse or domestic partner (or nominee thereof)
☐ Adult child (or nominee thereof)
☐ Parent (or nominee thereof)
☐ Adult sibling (or nominee thereof)
☐ Relative with whom Subject has resided for more than 6 months
☐ Other person — explain basis for appointment: [________________________________]

29. The Proposed Guardian affirms that he or she:

☐ Is at least 18 years of age
☐ Is not currently serving as guardian for three or more other persons (unless related)
☐ Has no conflict of interest with the Subject (or any conflict has been fully disclosed)
☐ Does not provide residential, medical, or other professional services to the Subject for compensation (or falls within the family-member exception under D.C. Code § 21-2043)
☐ Is willing and able to serve as guardian
☐ Will submit to a criminal background check as required by D.C. Code § 21-2043

30. Co-Guardian Requested?

☐ No
☐ Yes — Name of Co-Guardian: [________________________________]
Relationship to Subject: [________________________________]
Address: [________________________________]
Telephone: [________________________________]

VII. CRIMINAL HISTORY DISCLOSURE

Required under D.C. Code § 21-2043 and Superior Court Probate Division Rules.

31. The Proposed Guardian makes the following criminal history disclosure:

☐ The Proposed Guardian has no criminal convictions.

☐ The Proposed Guardian discloses the following criminal convictions:

32. ☐ A completed Statement of Criminal History form is attached as Exhibit B.

VIII. INFORMATION ABOUT THE SUBJECT'S ESTATE AND FINANCES

33. To the best of Petitioner's knowledge, the Subject has the following assets and income:

34. Is a Conservator also being sought?

☐ No — this petition seeks appointment of a Guardian of the Person only
☐ Yes — a separate or combined petition for conservatorship is being filed
☐ A conservator has already been appointed — Name: [________________________________]

IX. INTERESTED PERSONS AND NOTICE

D.C. Code § 21-2042 requires notice to the Subject and specified interested persons. The Subject may not waive notice.

35. The following persons are known interested persons who must receive notice of this proceeding:

36. Notice requirements under D.C. Code § 21-2042:

☐ Notice will be served personally on the Subject of this Petition
☐ The Petition will be served on the Subject by first class mail within 3 days of filing (per D.C. Code § 21-2041(c))
☐ A Certificate of Service will be filed with the Court
☐ Notice of Initial Hearing to Subject (court form) is attached
☐ Notice of Initial Hearing to Other Persons (court form) is attached

37. Are there any interested persons whose address is unknown?

☐ No
☐ Yes — Name(s): [________________________________]
Efforts made to locate: [________________________________]

X. REQUESTED POWERS OF THE GUARDIAN

Under D.C. Code § 21-2044(c), the court may limit the powers of a guardian and create a limited guardianship. Under D.C. Code § 21-2047, a general guardian has broad powers over care, custody, and control of the ward.

38. Petitioner requests the Court grant the Guardian authority over the following areas (check all that apply):

Personal and Health Care Decisions

☐ Consent to routine medical and dental treatment
☐ Consent to surgical and other non-routine medical procedures
☐ Consent to psychiatric or psychological treatment
☐ Consent to administration of medications, including psychotropic medications
☐ Make end-of-life and palliative care decisions (subject to D.C. Code § 21-2047.01 limitations)
☐ Access medical and health records
☐ Select and contract with health care providers
☐ Apply for health insurance and government benefits (Medicaid, Medicare, etc.)

Residential Decisions

☐ Determine the Subject's place of residence within the District of Columbia
☐ Determine the Subject's place of residence outside the District of Columbia (requires court approval)
☐ Consent to placement in an assisted living facility, nursing home, or group home
☐ Consent to temporary hospitalization

Personal and Social Decisions

☐ Make decisions regarding the Subject's social activities and interactions
☐ Manage the Subject's personal effects and property not subject to conservatorship
☐ Apply for and manage government benefits on behalf of the Subject
☐ Pursue legal action for support payments owed to the Subject
☐ Access the Subject's personal records (financial, educational, legal)
☐ Delegate certain responsibilities to the Subject as appropriate under D.C. Code § 21-2047

Other Requested Powers

☐ Other — specify: [________________________________]

39. The following powers are NOT requested, and the Subject retains decision-making authority in these areas:

[________________________________]

[________________________________]

PRACTICE NOTE: Under D.C. Code § 21-2047.01, guardians may NOT consent to abortion, sterilization, psychosurgery, organ removal (unless life-threatening), convulsive therapy, experimental treatment, aversive behavior modification, involuntary commitment, or waiver of fundamental legal rights without express court authorization.

XI. PROPOSED CARE PLAN

40. The Proposed Guardian intends to implement the following initial care plan for the Subject:

a. Residential Plan: [________________________________]

[________________________________]

b. Medical / Health Care Plan: [________________________________]

[________________________________]

c. Daily Living and Support Services: [________________________________]

[________________________________]

d. Social and Recreational Activities: [________________________________]

[________________________________]

e. How the Guardian will maintain contact with the Subject:

☐ Daily personal visits
☐ Weekly personal visits
☐ Biweekly personal visits
☐ Monthly personal visits
☐ Telephone / video contact — frequency: [________________________________]
☐ Other — specify: [________________________________]

f. Steps the Guardian will take to encourage the Subject's independence and self-reliance (per D.C. Code § 21-2047(a)(7)):

[________________________________]

[________________________________]

XII. BOND

41. Bond Request:

☐ Petitioner requests that bond be set in the amount of $ [________________________________] with surety acceptable to the Register of Wills

☐ Petitioner requests that bond be waived because:

☐ The guardianship is limited to the person only and does not involve management of the Subject's estate
☐ The Subject's estate is minimal (less than $ [________________________________])
☐ The Proposed Guardian is a corporate fiduciary
☐ Other grounds for waiver: [________________________________]

☐ Petitioner requests bond be set by the Court in its discretion

PRACTICE NOTE: Under D.C. Code § 21-115 and Superior Court Probate Division Rule 315, the court may require the guardian to post bond. Bond is typically required when the guardian will have authority over the ward's assets. The guardian must qualify within 14 days of appointment.

XIII. TEMPORARY / EMERGENCY GUARDIAN (IF APPLICABLE)

Complete this section only if requesting temporary appointment under D.C. Code § 21-2046.

42. ☐ Petitioner seeks appointment of a temporary guardian because:

☐ There is an immediate and substantial risk of harm to the Subject's health, safety, or welfare
☐ No other person with authority to act is reasonably available, mentally capable, and willing to act
☐ The current guardian is not effectively performing duties

43. Type of temporary guardian sought:

☐ Emergency Guardian (up to 21 days per D.C. Code § 21-2046(a))
☐ Health-Care Guardian (up to 90 days, renewable for additional 90 days, per D.C. Code § 21-2046(b))
☐ Provisional Guardian (up to 6 months per D.C. Code § 21-2046(c))

44. Facts demonstrating the emergency or need for temporary appointment:

[________________________________]

[________________________________]

[________________________________]

XIV. COURT-APPOINTED EXAMINER AND VISITOR

Under D.C. Code § 21-2041, the court shall appoint a qualified examiner and a separate visitor to evaluate the Subject and report to the court. The examiner and visitor must be separate persons. Under D.C. Code § 21-2033, the visitor shall interview the Subject, the Petitioner, the proposed guardian, visit the Subject's residence, and submit a written report.

45. Petitioner respectfully requests the Court appoint:

☐ A qualified examiner with expertise in: [________________________________]
☐ A visitor to interview the Subject and submit a report to the Court
☐ A guardian ad litem for the Subject (if the court determines one is necessary)

46. If the Subject has an intellectual disability, Petitioner requests appointment of a "qualified developmental disability professional" as examiner (per D.C. Code § 21-2041(d)).

☐ Applicable ☐ Not applicable

XV. APPOINTMENT OF COUNSEL FOR SUBJECT

Under D.C. Code § 21-2041(b), if the Subject is not already represented by counsel, the court shall appoint an attorney to represent the Subject.

47. Is the Subject currently represented by counsel?

☐ No — Petitioner requests the Court appoint counsel for the Subject
☐ Yes — Attorney Name: [________________________________]
Bar Number: [________________________________]
Address: [________________________________]
Telephone: [________________________________]

XVI. PRAYER FOR RELIEF

WHEREFORE, Petitioner respectfully requests that this Honorable Court:

a. Accept this Petition for filing and set the matter for hearing;

b. Appoint counsel for the Subject, if not already represented, pursuant to D.C. Code § 21-2041(b);

c. Appoint a qualified examiner and a visitor, as required by D.C. Code § 21-2041, to evaluate the Subject and report to the Court;

d. Issue notice of the hearing to the Subject and all interested persons as required by D.C. Code § 21-2042;

e. Upon hearing and a finding of incapacity by clear and convincing evidence, appoint [________________________________] as:

☐ General Guardian of the Person
☐ Limited Guardian of the Person, with powers limited to: [________________________________]
☐ Temporary Guardian (Emergency / Health-Care / Provisional)

of [________________________________] (Subject), pursuant to D.C. Code § 21-2044;

f. Issue Letters of Guardianship upon the Guardian's qualification and acceptance of appointment under D.C. Code § 21-2045;

g. Set bond in the amount of $ [________________________________], or waive bond as requested;

h. Grant such temporary protective orders as may be necessary to prevent harm to the Subject pending hearing;

i. Award such other and further relief as this Court deems just and proper.

XVII. VERIFICATION

I, [________________________________], being first duly sworn or affirmed, depose and state as follows:

1. I am the Petitioner in this matter.
2. I have read the foregoing Petition for Appointment of Guardian and know the contents thereof.
3. The statements made herein are true and correct to the best of my knowledge, information, and belief.
4. I understand that false statements are punishable under the laws of the District of Columbia.

Date: [__/__/____]

Signature: _______________________________________________

Printed Name: [________________________________]

XVIII. SIGNATURE OF PROPOSED GUARDIAN — CONSENT TO SERVE

I, [________________________________], hereby consent to serve as Guardian of [________________________________] if appointed by this Court. I understand and accept the duties and responsibilities of a guardian as set forth in D.C. Code § 21-2047, including but not limited to:

• Maintaining personal contact with the ward and understanding his or her needs and capacities;
• Making decisions using the substituted judgment standard or, if the ward's wishes are unknown, the best interest standard (D.C. Code § 21-2047(a)(6));
• Encouraging the ward's maximum self-reliance and independence (D.C. Code § 21-2047(a)(7));
• Filing reports with the Court as required, including semiannual status reports;
• Submitting to the jurisdiction of this Court in all matters relating to the guardianship (D.C. Code § 21-2045).

I further acknowledge that I have disclosed any criminal history as required and will submit to a background check.

Date: [__/__/____]

Signature: _______________________________________________

Printed Name: [________________________________]

XIX. NOTARIZATION

DISTRICT OF COLUMBIA )
) ss.
)

Subscribed and sworn to (or affirmed) before me this [____] day of [________________________________], 20[____], by [________________________________], who is personally known to me or who produced [________________________________] as identification.

Signature of Notary Public: _______________________________________________

Printed Name: [________________________________]

My Commission Expires: [__/__/____]

[NOTARY SEAL]

XX. ATTORNEY CERTIFICATION (IF REPRESENTED)

I, [________________________________], an attorney admitted to practice before the Superior Court of the District of Columbia (Bar No. [________________________________]), hereby certify that I have reviewed this Petition and that it is filed in good faith and in compliance with D.C. Code Title 21 and the Superior Court Rules of the Probate Division.

Date: [__/__/____]

Signature: _______________________________________________

Firm: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

XXI. REQUIRED EXHIBITS AND FILING CHECKLIST

The following documents must accompany or supplement this Petition:

Required at Filing

☐ This Petition for Appointment of Guardian (completed and verified)
☐ Medical evidence of incapacity (physician's report, psychological evaluation, or certification of incapacity under D.C. Code § 21-2204) — Exhibit A
☐ Statement of Criminal History for Proposed Guardian — Exhibit B
☐ Notice of Initial Hearing to Subject (court form)
☐ Notice of Initial Hearing to Other Persons (court form)
☐ Proposed Order Appointing Counsel, Examiner, Visitor, and/or Guardian Ad Litem
☐ Certificate of Service (showing service on Subject within 3 days per D.C. Code § 21-2041(c))
☐ Filing fee payment or fee waiver application
☐ Consent of Proposed Guardian to Serve (Section XVIII above or separate form)

Required Before or At Hearing

☐ Proof of service of notice on all interested persons (per D.C. Code § 21-2042)
☐ Examiner's written report (filed by court-appointed examiner)
☐ Visitor's written report (filed by court-appointed visitor)
☐ Proposed Guardianship Plan / Care Plan
☐ Bond documentation (if bond is required and not waived)

Required After Appointment

☐ Guardian's Oath (executed before issuance of Letters of Guardianship)
☐ Bond posting with Register of Wills (within 14 days of appointment if required)
☐ Initial Guardian's Report and Care Plan (within time ordered by Court)
☐ Semiannual reports to the Court on the ward's condition (per D.C. Code § 21-2047(a)(5))
☐ Annual report including physician's certificate (per court order)

XXII. CERTIFICATE OF SERVICE

I hereby certify that on [__/__/____], a true and correct copy of this Petition for Appointment of Guardian, together with all exhibits, was served upon the following persons by the method indicated:

Subject of Petition:

Name: [________________________________]
Method: ☐ Personal Service ☐ First Class Mail (within 3 days of filing per D.C. Code § 21-2041(c))
Date Served: [__/__/____]

Other Interested Persons:

PRACTICE NOTE: Under D.C. Code § 21-2042, notice must be served personally on the Subject. For other interested persons within D.C., personal service is required if they can be found. For persons outside D.C. or who cannot be found, notice is given under D.C. Code § 21-2031. The Subject may not waive notice.

Date: [__/__/____]

Signature: _______________________________________________

Printed Name: [________________________________]

Sources and References

• D.C. Code Title 21, Chapter 20 — Guardianship, Protective Proceedings, and Durable Power of Attorney
• D.C. Code § 21-2011 — Definitions
• D.C. Code § 21-2041 — Procedure for Court-Appointment of Guardian
• D.C. Code § 21-2042 — Notice; Guardianship Proceeding
• D.C. Code § 21-2043 — Who May Be Guardian; Priorities
• D.C. Code § 21-2044 — Findings; Order of Appointment
• D.C. Code § 21-2046 — Temporary Guardians
• D.C. Code § 21-2047 — Powers and Duties of General and Limited Guardian
• D.C. Code § 21-2047.01 — Limitations on Guardians
• D.C. Code § 21-2033 — Guardian Ad Litem; Counsel; Visitor
• D.C. Superior Court Rules of the Probate Division (Effective 8/22/2022)
• DC Courts — Intervention Proceedings (INT/IDD)
• DC Courts — Intervention Proceedings Forms
• DC Courts — Guardianship of Minors' Estates (GDN)
• DC Courts — Filing for Guardianship/Conservatorship of an Adult (Brochure)
• DC Courts — General Information and Forms for Guardians