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CC 395Mandatory

Petition for Personal Protection Order (Nondomestic Sexual Assault)

Michigan · Michigan State Court Administrative Office · Effective March 1, 2023

This form is a request to the court for a personal protection order specifically related to nondomestic sexual assault. It asks the court to issue orders that prohibit the respondent from certain actions, such as entering certain property or contacting the petitioner.

The court describes it as: Court rule / statute: MCL 600.2950a, MCR 3.703

Open the official PDFfrom Michigan State Court Administrative Office

Where this fits in a case

Start a case

Stage: Start a case

This form is used when a petitioner believes they need a personal protection order because of sexual assault or related threats, and the respondent is involved.

Usually filed by the person starting the case.

Common questions

Who fills out this form?
The petitioner fills out this form, and it also includes sections for the respondent to sign to acknowledge service.
What does the form ask for?
The form asks the court to grant a personal protection order that prohibits the respondent from various actions, such as contacting the petitioner or entering certain property.
Is there a fee involved?
The form includes sections to calculate and pay a total fee, which may include service fees, incorrect address fees, and mileage.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect March 1, 2023.

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