INDIAN CHILD WELFARE ACT (ICWA) NOTICE

NOTICE TO INDIAN PARENT, INDIAN CUSTODIAN, AND INDIAN TRIBE

Case Number: [________________________________]

Court: [________________________________]

County/State: [________________________________]

PART I: CASE INFORMATION

Case Caption:

In the Matter of:

Child's Name: [________________________________]

Date of Birth: [__/__/____]

Current Placement: [________________________________]

PART II: NOTICE OF PENDING PROCEEDING

TO:

☐ Parent(s) of the above-named child
☐ Indian Custodian(s) of the above-named child
☐ Indian Tribe(s) with which the child may be affiliated
☐ Secretary of the Interior (Bureau of Indian Affairs)

Name of Recipient: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

YOU ARE HEREBY NOTIFIED that:

Pursuant to the Indian Child Welfare Act, 25 U.S.C. § 1912, a proceeding has been initiated in the above-captioned court that may result in:

☐ Foster care placement of the above-named child
☐ Termination of parental rights to the above-named child
☐ Preadoptive placement of the above-named child
☐ Adoptive placement of the above-named child

PART III: HEARING INFORMATION

Date of Hearing: [__/__/____]

Time: [____:____] ☐ AM ☐ PM

Location: [________________________________]

Courtroom: [________________________________]

Judge/Hearing Officer: [________________________________]

Purpose of Hearing: [________________________________]

PART IV: RIGHTS UNDER ICWA

A. Right to Intervene

Under 25 U.S.C. § 1911(c), the Indian custodian of the child and the Indian child's tribe have the right to intervene at any point in the proceeding.

B. Right to Petition for Transfer

Under 25 U.S.C. § 1911(b), in any State court proceeding for foster care placement or termination of parental rights, the Indian custodian or the child's tribe may petition the court to transfer the proceeding to the jurisdiction of the tribe, absent:
- Objection by either parent
- Declination by the tribal court
- Good cause to the contrary

C. Right to Request Additional Time

Under 25 U.S.C. § 1912(a), no foster care placement or termination of parental rights proceeding shall be held until at least ten (10) days after receipt of this notice. The parent, Indian custodian, or tribe may request up to twenty (20) additional days to prepare for the proceeding.

D. Right to Counsel

Under 25 U.S.C. § 1912(b), the parent or Indian custodian has the right to court-appointed counsel in any removal, placement, or termination proceeding if the court determines that the parent or Indian custodian is indigent.

PART V: CHILD AND FAMILY INFORMATION

A. Child Information

B. Biological Mother Information

C. Biological Father Information

D. Maternal Grandmother

E. Maternal Grandfather

F. Paternal Grandmother

G. Paternal Grandfather

H. Other Known Indian Ancestors

[________________________________]

[________________________________]

[________________________________]

PART VI: INFORMATION ABOUT THE PROCEEDING

Petitioner/Agency Name: [________________________________]

Address: [________________________________]

Telephone: [________________________________]

Attorney for Petitioner: [________________________________]

Attorney Address: [________________________________]

Attorney Telephone: [________________________________]

Summary of Allegations/Circumstances:

[________________________________]

[________________________________]

[________________________________]

[________________________________]

PART VII: TRIBAL RESPONSE REQUESTED

The tribe is requested to provide, within 30 days of receipt of this notice:

☐ Confirmation whether the child is a member or eligible for membership in the tribe
☐ Confirmation whether a biological parent is a member
☐ Whether the tribe wishes to intervene in the proceeding
☐ Whether the tribe requests transfer to tribal court
☐ ICWA Placement Preferences or tribal customary adoption preferences
☐ Other information relevant to the child's tribal status

PART VIII: COPY OF PETITION

☐ A copy of the petition initiating this proceeding is attached hereto.

PART IX: CERTIFICATION

I, [________________________________], certify that this notice has been sent by Registered Mail, Return Receipt Requested, to the above-named recipients on [__/__/____].

Signature: [________________________________]

Printed Name: [________________________________]

Title: [________________________________]

Date: [__/__/____]

RETURN RECEIPT TRACKING

INSTRUCTIONS FOR COMPLETING THIS NOTICE

Identification of Tribes

1. Use the BIA's published list of ICWA Designated Agents to send notice to the correct tribal contact
2. If the tribe is unknown, send notice to the BIA Regional Director for the child's residence
3. If multiple tribes may be implicated, send notice to ALL potentially affiliated tribes

Required Information

Under 25 C.F.R. § 23.111, the notice must include:
- Name, birthdate, and birthplace of the child
- All names known of the parents, grandparents, and great-grandparents
- Birthdates and birthplaces of the above family members, if known
- Tribal enrollment numbers, if known
- Other identifying information, if known
- A copy of the petition

Service Requirements

• Service must be by Registered Mail, Return Receipt Requested
• Proof of service must be filed with the court
• No proceeding may be held until at least 10 days after receipt of notice

SOURCES AND REFERENCES

• Bureau of Indian Affairs - ICWA
• 25 C.F.R. Part 23 - ICWA Regulations
• Native American Rights Fund - ICWA Guide
• National Indian Child Welfare Association

This notice complies with the Indian Child Welfare Act, 25 U.S.C. § 1901 et seq., and implementing regulations at 25 C.F.R. Part 23.