Volunteer Application (0650)

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CASA for Douglas County Volunteer Application

Qualifications and Personal Information

Thank you so much for your interest in becoming a Court Appointed Special Advocate (CASA) Volunteer! The volunteer work that you are considering will forever change the life of a child who has experienced abuse and/or neglect. As you would expect with this type of work with children, we must take special care to screen all volunteers, therefore this application has many questions. Thank you for your patience and understanding in this application process. Last sentence on that page should say We look forward to working with you!

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Qualifications

Are you at least 21 years old?*

Yes

Will you be able to fulfill a TWO year commitment to remain active on a case which you accept through your appointment by the court?*

Yes

A Social Security Number is required to complete our background checks. Do you have a Social Security Number?*

Yes

Did you read and understand the CASA Volunteer Job Description on our website?*

Yes

Do you have access to a computer with a high speed internet connection and a current web browser?*

Yes

Do you consider yourself comfortable with technology (email, Microsoft Word, Zoom)?*

Yes

Are you able to complete approximately 30 hours of pre-service training?*

Yes

Personal Information

First Name*

Middle Name*

Last Name*

AKA

Address*

Street Address Address Line 2 City State ZIP Code

County*

Personal Email*

Enter Email Confirm Email

Work Email

Enter Email Confirm Email

Home Phone

Mobile Phone*

Work Phone

Best Phone*

Home

Mobile

Work

Date of Birth*

MM slash DD slash YYYY

Birth City

Birth State

Gender*

Male

Female

Race*

African American/Black

American Indian/Alaska Native

Asian

Caucasian

Multi-Racial

Native Hawaiian/ Pacific Islander

Ethnic Origin*

Hispanic/Latino

Not Hispanic or Latino

Marital Status*

Single

Married

Divorced

Separated

Widowed

Primary Language

Education*

Degree Type

Major

Contact Information

Please tell us about the people who live with you.

Spouse/Partner

Name

First Middle Last

Phone

Company

Position/Title

Children

Child #1

First Middle Last

Age

Gender

Child #2

First Middle Last

Age

Gender

Child #3

First Middle Last

Age

Gender

Child #4

First Middle Last

Age

Gender

Child #5

First Middle Last

Age

Gender

Emergency Contact*

First Last

Phone*

Phone 2

Experience

As we get to know you better, please tell us about any experience you have had, either personally or professionally, in the following areas. Please note, experience is not required to become a CASA Advocate. If you answer "YES" to any question, please provide a brief narrative in the box provided.

Child Protective Agencies*

Yes

If yes, please explain:*

Foster Care*

Yes

If yes, please explain:*

Juvenile Court*

Yes

If yes, please explain:*

Other Child Service Agencies*

Yes

If yes, please explain:*

Child Abuse or Neglect*

Yes

If yes, please explain:*

Domestic Violence*

Yes

If yes, please explain:*

Mental Illness/Mental Health Treatment*

Yes

If yes, please explain:*

How did you hear about our program?*

Volunteer Experience

Beginning with the most recent, list your history for your volunteer experiences over the past five years.

Most recent position