Volunteer Application (0268)

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CASA of Santa Barbara County Volunteer Application

Thank you for applying to become a CASA volunteer! If you have trouble with this form, please contact volunteer@sbcasa.org or call 805-868-8890. We are happy to provide a paper application if that is preferred.

CAPTCHA

Qualifications

l am over 21 years old and have read the information about and want to become a volunteer:*

Yes

Name*

First Last

Email Address*

Enter Email Confirm Email

I am willing to serve on a case in (select all that apply):*

Santa Barbara/ Goleta/ Carpinteria

Santa Maria/ Guadalupe

Lompoc/ Santa Ynez Valley

I can serve anywhere in the county

Personal Information

Date of Birth*

MM slash DD slash YYYY

Home Address*

Street Address Address Line 2 City State ZIP

Mobile Phone*

Home Phone

Work Phone

Preferred Phone Number*

Driver's License Number

State

Exp. Date

Marital Status*

SIngle

Married

Separated

Legally Separated

Divorced

Widowed

Gender*

Employment Information

Current Employment Status*

Full Time

Part Time

Retired

Stay at Home

Disabled

Student

Unemployed or Seeking Employment

Company*

Job Title*

Describe any personal or employment constraints that may restrict your availability*

Have you served in the armed forces?*

Yes

Duration*

Description*

Education Information

High school: Highest grade completed*

College, graduate, post-graduate completed (highest level)

Major*

Degree*

How did you become aware of the CASA program?

Are you aware that you will be required to complete training?*

Yes

Are you willing to participate in ongoing training and court appearances?*

Yes

List community service organizations or club to which you belong:

Previous and/or current volunteer activities:

Successful completion of 30 hours of initial training is required prior to acceptance into the CASA program. If given advance notice of the training schedule, will you be able to commit to this training?*

Yes

Do you have training and/or work experience in any of the following areas? Please check all that apply.

Child care

Child development

Counseling

Criminology

Drug/alcohol abuse

Health care

Law

Law enforcement

Mental health

Psychology

Public speaking

Writing

Race*

Ethnicity*

Primary Language*

Other Language*

Are you willing to work with all ages of children?*

Yes

I prefer ages:*

0-5

6-12

13-17

Please be aware that CHILDREN ARE FREQUENTLY MOVED. If you have a preference in the county area where you would be wiling to acept a case asignment, you may be required to travel to other areas in the county to maintain contact with the child to whom you are assigned.

Would you be willing to travel to maintain contact?*

Yes

Possibly

Background Information

Have you been:

Arrested for a crime against a child?*

Yes

If yes, please explain:*

Arrested for a violent felony?*

Yes

If yes, please explain:*

Arrested for a sex crime?*

Yes

If yes, please explain:*

Convicted of any crime (excluding vehicle code infractions, but including vehicular misdemeanors or felonies? Disclaimer DUI, misdemeanors, etc...)*

Yes

If yes, please explain:*

Please note - drug/substance (DUI/DWI) violations: Violations under 5 years are reason for exclusion from serving as a CASA volunteer due to Program Policy and Insurance requirements.

Are you currently undergoing prosecution for any crime ( excluding vehicle code in fraction , but including vehicular misdemeanors and felonies )?*

Yes

If yes, please explain:*

Have you ever been arrested convicted of a crime not mentioned above?*

Yes

If yes, please explain:*

Are you, or have you ever been, the sibling, household member, parent, significant other or spouse of a child who has been the subject of a report to a Child Protective Agency?*

Yes

If yes, please explain:*

Are you, or have you ever been , the sibling, household member, parent, significant other or spouse of a child who has been an adjudicated dependent of any juvenile court?*

Yes

If yes, please explain:*

Are you, or have you ever been, the sibling, household member, parent, significant other or spouse of a child who has been placed under informal supervision in any county's children Social Service Agency?*

Yes

If yes, please explain:*

Are you currently paid or reimbursed to provide a service to children and/or parents within the Child Welfare and/or Juvenile Court System?*

Yes

If yes, please explain:*

Have you had a personal experience involving (check all that apply)

Child Welfare

Foster Care

Juvenile Court

Other agencies offering services to a child

If you selected any of the above background questions, please explain.*

References

Please list three (3) personal references. One must be employer or co-worker if employed. Teachers, ministers, volunteer supervisors or similar may be used in place of employer if unemployed. Please do not list relatives.

All references will be emailed a questionnaire to complete. Application approval is pending receipt of at least three returned references.

Reference 1 Name*

First Last

Relationship*

Email*

Enter Email Confirm Email

Reference 2 Name*

First Last

Relationship*

Email*

Enter Email Confirm Email

Reference 3 Name*

First Last

Relationship*

Email*

Enter Email Confirm Email

Submit

After submitting your application, be sure to RSVP for an into session with a CASA staff member . I certify that the above information is true and correct to the best of my knowledge and belief. I understand and agree that any false statement or omission of material fact will cause my immediate and unconditional dismissal from the Court Appointed Special Advocate program.

Certify*

I agree to and accept the terms and conditions above.

Name & Date