Volunteer Application Download & Print Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4 Email to Contact Date *How did you hear about the CASA Program? *General InformationName *FirstLastSex *MaleFemaleEthnicity *African AmericanCaucasianHispanicAsianMulti-EthnicOtherMarital Status *MarriedSingleSingle AgainContact InformationHome PhoneWork PhoneCell PhonePreferred Contact *CellHomeWorkEmail Address *Would you like to receive emails from CASA? *YesNoHome Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYears at Current Residence *1234567+If less than 7 Years, Please List Previous Residence *Emergency Contact Name *FirstLastEmergency Contact Phone Number *NextEmployment InformationPlease choose any of the following statuses that apply *MilitaryStudentEmployment Status *Part-TimeFull-TimeRetiredUnemployedContractEmployer *Position *Length of Employment<1 Year1 Year2-4 Years5+ YearsWork AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEducation/Skills InformationPlease select highest level completedSome High SchoolHigh SchoolSome CollegeCollege-GraduatePost-GraduateLanguagesEnglishChineseFrenchGermanKoreanSpanishVietnameseSelect any training or experience (salaried or volunteer) in any of the following categories: (NOTE: None is required to be a CASA Volunteer.)Child CareChild DevelopmentChild WelfareEducationArts/GraphicsFundraisingDrug/Alcohol Treatment ProgramsHealth / Mental HealthCounseling / PsychologyPublic SpeakingSocial WorkHuman ResourcesCriminology / Law EnforcementNews / MediaWriting / EditingJuvenile CourtAdvertising / Public RelationsLawDescribe any additional experiences that may be applicable to CASA.List current and previous volunteer service and length of service.Have you ever been involved with another CASA program?YesNoIf yes, which CASA program(s) and what was your role?Have you ever worked for the juvenile court? *YesNoHave you ever worked for the Dept. of Family & Children Services or Child Protective Services? *YesNoHave you ever been a foster parent? *YesNoList any charges, arrests, and/or convictions, other than traffic violations, and list dates, county/state, and disposition of each. (An applicant having a charge or conviction for a crime involving a sex offense, child abuse or neglect or related acts that would pose risks to children or the CASA program’s credibility is disqualified as a CASA volunteer. Applicants with other misdemeanor or felony charges or convictions that would not pose a risk to children or negatively affect the credibility of the CASA program will be considered on a case-by-case basis considering the time passed since the incident and the level of rehabilitation.) Have you ever had a case with, or investigation performed by, the Department of Family and Children Services? *YesNoIf yes, Please Explain:NextTraining InformationWhen can you attend CASA training? Please check available times:Monday MorningMonday AfternoonMonday EveningTuesday MorningTuesday AfternoonTuesday EveningWednesday MorningWednesday AfternoonWednesday EveningThursday MorningThursday AfternoonThursday EveningFriday MorningFriday AfternoonFriday EveningSaturday MorningSaturday AfternoonSaturday EveningSunday MorningSunday AfternoonSunday EveningIf relevant, please choose any specific days when you cannot attend:MondayTuesdayWednesdayThursdayFridaySaturdaySundayDo you prefer to work w/a particular age group?0-23-56-89-1213-1516-18N/ADo you have access to transportation?YesNoDo you have a driver’s license?YesNoIf yes, license number:State of License:I affirm I have automobile insuranceNextReferencesPlease list names and contact information of 4 people (2 professional – salaried or volunteer work – and 2 personal – no family members, please). If currently employed, please list supervisor first. *Essay QuestionsWhy do you want to be a CASA volunteer? *What role should society play in protecting children while also preserving families? *Please write an autobiographical statement. *As a CASA volunteer, I will be willing to do the following: (please check each box for “Yes”)Commit a minimum of 12 – 24 months to being a CASA volunteer (determined by CASA program)Participate in the CASA program’s 30+ hour volunteer trainingParticipate in 12 hours of continuing education training annuallyVisit in person with the child(ren) to whom I may be assigned at least monthlyPrepare written reports to the court with guidance from CASA staffParticipate and attend court hearings and meetings on my child’s case during business hoursRecord and turn in a monthly log of my activities on my caseDisclose any criminal charge(s) if brought against me while serving as a CASA volunteerAFFIRMATION AND RELEASE *I hereby affirm that the information contained in this application is correct and accurate to the best of my knowledge. I understand that this information will be used in determining my eligibility as a Court Appointed Special Advocate, as well as to support any ongoing involvement with CASA. I understand that completing this application or gaining acceptance into the training does not of itself guarantee confirmation that I will be sworn in as a CASA volunteer or be appointed to a case and that such a decision is made after the entire screening and training process have been successfully completed. I further understand that both the CASA program and I have the ability to individually or mutually terminate this relationship at any point. This decision may occur at any time in the screening process, including after the interview or during the training, or after I am sworn in as a CASA volunteer. Any knowingly false or misleading statements or omissions made on this application or otherwise stated during the screening process shall be automatic grounds for dismissal. I understand that the CASA program will protect and maintain my personal information. Information is collected and stored for purposes related to the recruitment, screening, training and retention of CASA volunteers and will not be sold to third parties. Upon successful completion of my screening, training and acceptance as a volunteer, I understand that I will be expected to serve as an advocate for a length of time* as agreed upon/discussed with the CASA program personnel. If unforeseen circumstances prevent me from fulfilling this obligation, I will provide as much notice as possible and follow any procedures for notice, release and return of case-specific information, both digital and physical. I am aware that I may have access to sensitive information during training and court observation. During training, I will be provided with detailed information about how to protect and maintain confidential documents, reports, evaluations and other material in my capacity as a CASA volunteer to avoid any unauthorized disclosure.Date Submitted *Submit
