Volunteer Application ( 1347 )

CASA of Medina County Volunteer Application

Please fill out the application completely and we will be in contact with you shortly. We value each persons' unique background, expertise and experience and strive to create a volunteer base that affirms and is representative of the children we serve. Please note, all demographics questions are used for the sole purpose of ensuring that we are aware of who we have not reached yet.

CAPTCHA

Personal Information

Email*

Enter Email Confirm Email

Name*

First Middle Last

Mobile Phone*

Home Phone

Work Phone

Best Phone*

Are you at least 21 years old?*

Yes

No

Date of Birth*

Are you a U.S citizen?*

Yes

No

What is your race/ ethnicity (ies)? Check all that apply

American Indian / Alaska Native

Asian or Asian American

Black / African American

Hispanic, Latinx

Native Hawaiian

White / Caucasian

Another option not listed here

I prefer not to answer this question

Please indicate your gender.*

Female

Male

Non-binary

Another option not listed here

I prefer not to answer this question

Ethnicity*

Hispanic/Latino

Not Hispanic or Latino

Unknown

Another option not listed here

I prefer not to answer this question

Address Information

Home Address*

Street Address Address Line 2 City State ZIP

How long have you been at current address?*

Previous Address if you have moved in the last seven years

Street Address Address Line 2 City State ZIP

Who all lives in your household and what is their relationship to you?

Employment and Experience

Employment Status*

Full Time

Part Time

Not Employed

Retired

Full-time Student

Part-time Student

Current Employer*

Employer Address*

Street Address Address Line 2 City State ZIP Code

Highest Level of Education*

Name of School*

Degree Completed*

Major/Field of Study*

Any volunteer or job related experience dealing with youth, juvenile justice system, etc. ?*

Are you presently a volunteer in any capacity?*

Yes

No

If yes, indicate position, agency, amount of hours committed monthly.*

List any specific skills/qualifications that you have that would be of value to CASA.*

Please write a short summary about your interest in volunteering, how you hope to benefit from the volunteer experience and explain why you hope to volunteer your time with CASA of Medina County?*

Personal References

Please provide name, phone and email of three references for you. Please alert your references that we will be in contact with them. References should not be family members.

Reference 1 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

How long have you known them?*

Reference 2 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

How long have you known them?*

Reference 3 Name*

First Last

Phone*

Relationship*

Email*

Enter Email Confirm Email

How long have you known them?*

Sign and Certify

Submitting the application electronically authorizes this check and confirms that to the best of your knowledge, information contained in this completed application is true. Any checks or inquires will be kept in strict confidence.

Name & Date