Statement of Active Efforts - Indian Child Welfare Act

This form asks for information about the steps taken to try and keep an Indian child with their family, as required by the Indian Child Welfare Act. It asks questions about efforts made with the child's tribe and family members.

The court describes it as: To provide information for the court to determine whether active efforts were made to prevent the breakup of the Indian family in cases subject to the Wisconsin Indian Child Welfare Act (WICWA).

Official instructions

How-to guides published by the court for this form.

• Plain-language summary↗

Common questions

Who fills out this form?

The form includes spaces for a signature, suggesting it is completed by someone involved in the case. The form is titled for the court to review.

What is the purpose of this form?

It is used to provide the court with information about active efforts made to prevent the breakup of the Indian family under the Indian Child Welfare Act.

Revision history

No changes recorded since we started tracking this form on October 10, 2026. The current version took effect November 21, 2019.

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