Request for Qualified Expert Witness (QEW) Form

Case #*

Caseworker's Email*

Caseworker's Phone Number

Phone

Caseworker's Supervisor's Name*

Tribe (Select all that apply)*

Select

Other Tribe(s)

Please fill in if you know the Tribe.

Are the parent(s) or child(ren) eligible or enrolled members?*

Select or enter value

Tribal Contact Person and email address*

Efforts made to obtain a QEW*

List attempts to contact Tribe(s) to request a QEW (including dates and mode of communication). Please do not list tribe contact information.

*Do not include NAIR and ICW Legal in this section

Court Hearing Type*

Select or enter value

Hearing Date*

Hearing Time*

County Court*

Select or enter value

Consulted with AAG?*

YES

NO

Pending

Name of AAG

Additional Information

Please include any additional information that would be helpful for OTR in locating a QEW:

Send me a copy of my responses