CASA Application test

To submit via the website, please fill out the form below. Once you click submit, you should see a message that says your information has been submitted.
If you have not heard from a staff member within 1 business day, please email us directly at [email protected]. We have recently had problems with applications coming through the website. We are working to resolve this issue.

* Indicates required field

How did you hear about the CASA program? *

Please feel free to add additional information on how you heard about us if needed or if you picked other. *

General Information

Name *

First

Last

SSN *

Date of Birth *

Sex *

Ethnicity *

Marital Status *

Contact Information

Preferred Phone Number *

Secondary Phone Number *

Type *

Email *

Emergency Contact Person *

Would you like to receive emails from CASA? * *

Emergency Contact Number *

Home Address *

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City

State

Zip Code

Country

Mailing Address (if different from above) *

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City

State

Zip Code

Country

Years at current home address? *

If less than 7 years, list previous address *

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City

State

Zip Code

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Employment Information

Please choose any of the following statuses that apply *

Military Student

Type of Employment *

Please fill out employment information below unless unemployed

Employer *

Length of Employment *

Position *

Work Address *

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City

State

Zip Code

Country

Education/Skills Information

Please select highest level completed *

Name of School and Degree Obtained *

Primary Language *

Please share other languages *

Select any training or experience (salaried or volunteer) in any of the following categories

(NOTE: None is required to be a CASA Volunteer.)

Describe 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 or applied at another CASA program? *

If applicable, what was your role? *

Have you ever worked for the juvenile court? * *

Have you ever worked for the Dept. of Family & Children Services or Child Protective Services? *

Have you ever been a foster parent? *

Are you currently or is your home still open? *

List 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.)

Comment *

Have you ever had a case with, or investigation performed by, the Department of Family and Children Services? *

If yes, please explain: *

Have you sought treatment for or are you currently in treatment for a mental health problem? *

Additional information: *

Training Information

When can you attend CASA training? Please check available times:

Do you prefer to work with a particular age group? *

Do you have access to transportation? *

Drivers License # *

State of license: *

I affirm I have automobile insurance. *

Reference

Please 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.

Name *

First

Last

Relationship *

Phone Number *

Email *

Address *

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State

Zip Code

Country

Name *

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Last

Relationship *

Phone Number *

Email *

Address *

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State

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Name *

First

Last

Relationship *

Phone Number *

Email *

Address *

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State

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Name *

First

Last

Relationship *

Phone Number *

Email *

Address *

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State

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Essay Question

Please briefly answer the following questions. (Two to four sentences each is sufficient.)

Why do you want to be a CASA volunteer? *

What role should society play in protecting children while also preserving families? *

Upload a short autobiography

Do more than list your milestones. Please cover a brief overview of your neighborhood and family life, your early role models and your adult accomplishments. Include, where possible, some analysis of your life’s direction and some discussion of goals met and future goals.

Short Autobiography *

Max file size: 20MB

As a CASA volunteer, I will be willing to do the following: *

Commit a minimum of 12 – 24 months to being a CASA volunteer Participate in the CASA program’s 50+ hour volunteer training Participate in 12 hours of continuing education training annually Visit in person with the child(ren) to whom I may be assigned at least monthly Prepare written reports to the court with guidance from CASA staff Participate and attend court hearings and meetings on my child’s case during business hours Record and turn in a monthly log of my activities on my case Disclose any criminal charge(s) if brought against me while serving as a CASA volunteer

*Varies by program, generally 12-24 months

I have read and agree to the duties listed above: *

Affirmation 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

Full Name *

Date *

DISCLAIMER: By typing your name, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

The criteria used in the selection of CASA volunteers are designed to ensure that the individual is able to meet the responsibilities of a CASA volunteer.