September 6, 2021

DIRECTIVE #19-21 - Standard Juvenile Intake Screening Form

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DIRECTIVE #19-21

Standard Juvenile Intake Screening Form August11,2021

This promulgates for immediate statewide use a standard Juvenile Intake Screening Form (CN 12833), as approved by Judicial Council. The purpose of the form is to assist the court in determining (based on the severity of the charges) whether a juvenile delinquency case should be addressed either by judge or by a court diversion program. To ensure consistency in that screening, the attached form sets forth the statutory factors that are to be applied when screening a case under N.J.S.A. 2A:4A-71.

More serious matters proceed to a judge for review with legal counsel representing the youth. Less serious matters, in contrast, are referred to court diversion programs, which have the youth and their parent(s)/guardian(s) (1) meet with a group of judiciary volunteers (Juvenile Conference Committee JCC) or court staff person (Intake Service Conference)(ISC)(2) referred to a county Family Crisis Intervention Unit (FCIU) for services; or (3) appear before a juvenile referee.

In these court diversion programs, the delinquency charges are addressed without requiring legal counsel for the youth. For matters addressed by JCC or by ISC, the youth and parent(s)/guardian(s) enter into an agreement to resolve the charges, which if approved by the judge, results in the case being dismissed once the diversion is completed successfully. For matters diverted to FCIU, the court enters an order referring the case to FCIU, and the case is dismissed. For matters diverted to a juvenile referee, the referee conducts an adjudicatory hearing and makes a recommendation to the judge for approval. The juvenile referee may find that the youth committed an act of delinquency and recommend a disposition or find the youth did not commit an act of delinquency and recommend dismissal.

ADA

Americans with Disabilities Act

ENSURING

AN OPEN DOOR TO JUSTICE

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Directive #19-21
Family/Juvenile - Standard Juvenile Intake Form August 
112021
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Please share this directive and the attached form with your judges and staff.

Attachment: CN 12833 - Standard Juvenile Intake Screening Form cc: Chief Justice Stuart Rabner

Acting Attorney General Andrew Bruck
Public Defender Joseph 
E. Krakora
Lyndsay Ruotolo, Director, Div. of Criminal Justice County Prosecutors
Steven D
Benville, Judiciary Chief of Staff
AOC Directors and Assistant Directors
Clerks of Court
Special Assistants to the Administrative Director
Amelia Wachter-Smith, Chief, Family Practice
Michele Walsh, Assistant Chief, Family Practice Assistant Family Division Managers
Emily Mari, Esq 
., Staff Attorney, Family Practice Division

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In the Matter of
Juvenile Name
County
Municipality/Arresting Agency Offense(s)

Co-Delinquents/Adult Co-Defendants (if any) Screening

Factors considered (N.J.S.A. 2A:4A-71)

Risk that ·uvenile resents a substantial dan er to others Famil Circumstances
First Offense
Prior diversion or referee

Number of Prior Diversions._ _ _
Number Successful:
Char e(s)
Number 
of Prior Delinquency Adjudications (Non-VOP):

Most Serious Prior Ad'udication

Last Disposition Type:
□ Diversion (FCIU, JCC, ISC) □ Adjudication In ut of victim or arrestin aenc
Arnenabili to remedial education 2A:4A-71. l) Probation or Deferred status
Dual status (open FN)

Party ID

Gender Birth Date

Docket Number
Race
Age at Time 
of Offense Inctdent Date

Prosecutor Comments

Residence

Date recommendation and file forwarded to the Judge:
Was Youth 
in Detention at Time of Screening If Not Diverted (FCIU, JCC, ISC), Why Not?

Yes No
Recommendation 
of the Juvenile Unit (Family Comi): Divert: FCIU JCC DISC

Referee Court Transfer

Published: 08/2021 CN: 12833

page 1of2

Initials

New Jersey Judiciary

Juvenile Intake Screening Form

Famil

Court Comments

Name of Officer Screening Complaint:

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·1ItkS 'F
Date complaint received by the Prosecutor's Office:

Date screened:
Date complaint/recommendation forwarded to the Family Division

Recommendation of the Assistant Prosecutor

Divert: □ FCIU
Referee Court Transfer _ _ _ _ _ _ _ _

Recommendation o f the Assistant Prosecutor

Hearing Required with notice to all parties? Yes No Date of Hearing: Comments

Date Judge's Signature

Divert: □ FCIU □ JCC □ ISC

To Be Completed by Juvenile Prosecutor Team

□ JCC
□ Dismissal □ Should be Stationhouse Adjustment

□ ISC

Prosecutor Consent to Court Intake Diversion Recommendation: □ Yes □ No (hearing requested) □ NIA

To Be Completed by Juvenile Judge If There Is a Conflict

Referee

Court

Transfer

Rule 5:20-l(c) states:
Court Intake Services Referral. Every complaint alleging juvenile delinquency shall be reviewed by court intake 
services in the manner provided by law for recommendation as to whether the complaint should be dismissed, diverted or referred for further court actionWhere the complaint alleges conduct which, if committed by an adult, would constitute a crime as defined by N.J.S. 2C: l-4a or a repetitive disorderly persons offense as defined by N.J.S. 2A:4A-22(h), or any disorderly persons offense as defined in chapter 35 or chapter 36 of Title 2C, the matter shall not be diverted by the court unless the prosecutor consents thereto. Nothing in this rule precludes the court from diverting any complaint pursuant to N.J.S. 2A:4A-73(a) after a hearing wherein all parties have an opportunity to be heard.
Published: 08/2021CN: 12833 page 2 of2

Initials: Initials: Initials: