The application below is a preliminary application to become a CASA volunteer. A more detailed application will be required before the process can be completed.

First Name:


Middle Name:


Last Name:


Address:


City:


County:


State:


Zipcode:


Mailing Address (if different):


City:


County:


State:


Zipcode:


Daytime Phone:


Evening Phone:


Sex:
MaleFemale

Email Address:


Ethnic Orgin:


Current Employer:


Address:


Phone:


Length Of Employment:


Position / Occupation:


Have You Ever Worked For The Juvenile Court?:
NoYes

Have You Ever Worked For DFCS?:
NoYes

List Any Volunteer Experience & How Long


List Any Other Experience, Education, Or Training Related To Dependent Children And Families:


Have You Ever Been Convicted Of A Crime (Do Not List Traffic Offences)

NoYes

Have You Sought Or Are You In Treatment For A Mental Helath Problem?
NoYes

Have You Ever Had A Case With DFCS?
NoYes

(If yes, by submitting this application you are providing consent for CASA to contact DFCS regarding the above mentioned case.)

How Did You Hear About The CASA Program?:


Why Do You Want to Volunteer For CASA?: