Volunteer Application (1173)

"*" indicates required fields

Step 1 of 14

Fox Cities CASA Volunteer Application

Important: Before You Begin

• The application will take approximately 30-60 minutes to complete. There is an option to Save and Continue Later if needed.

• If the application times out due to inactivity and you have not selected to Save and Continue Later, you will need to start over.

• Do not use the back button on your web browser. If you need to return to the previous page, use the "Previous" button at the bottom of the page.

• Tip: We suggest formulating your answers in a Word document and then copying and pasting the information into your application. You can find the application topics and questions below.

Instructions:

1. Please read the directions carefully and complete all sections of the application thoroughly.

2. To complete this application, you will need the following

a. Your driver’s license number and insurance information

b. Emergency contact information

c. Names and emails of 3-4 people we can contact for references

3. You may want to prepare answers to the open-ended question in advance to avoid losing your progress.

Please contact us at (920) 257-4733 if you have any questions about the application process.

CAPTCHA

Qualification

1. Qualification: Are you at least 21 years old?*

Yes

If not, please contact the volunteer recruiter at 920-257-4733 to discuss your options.

Your Information

2. Name*

3. Legal First Name*

4. Legal Middle Name

5. Legal Last Name*

6. Your Pronouns

7. Aliases

8. Marital Status*

Single

Married

Domestic Partnership

Divorced

Widowed

Prefer not to say

Home Address*

9. Address 1 - House number & street name 10. Address 2 - Apartment or Suite Number 11. City 12. State 13. Zipcode

14. County

15. Email address that you check regularly*

Enter Email Confirm Email

16. Primary Phone Number with Area Code (required)*

17. Secondary Phone Number with Area Code (mobile?)

Preferred Phone Number*

18. Birthdate*

MM slash DD slash YYYY

19. How long have you lived in the state of Wisconsin?*

20. What other states, if any, have you lived in? If none, please state "N/A".*

21. Which best represents your gender? Select all that apply.*

Man

Woman

Trans

Non-Binary

Gender nonconforming

Genderqueer

Gender-expansive

A-Gender

Prefer not to say

Other

If other, please specify:

22. Race

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino of any race

Native Hawaiian or other Paciu0000c Islander

Two or more races

White

Unknown or Unable to determine

Other

If other, please specify:

23. Primary Language*

24. Secondary Language(s)

25. How did you hear about our program? Select all that apply*

Radio

Volunteer Fox Cities and/or Get Connected Website

VolunteerMatch

WI State CASA Website

CASA of the Fox Cities Website

Facebook

Referred by a CASA

Referred by a staff member

Referred by a board member

The Post-Crescent

Spectrum One News

Presentation to my group

Other

If other, please specify:

Emergency Contact

Tell us who we should contact if we become aware of an emergency during your service, or if we haven't been able to connect with you to assess your safety.

26. First & Last Name*

27. Relationship to Applicant*

28. Phone Number*

29. Secondary Phone Number

30. Email

Enter Email Confirm Email

Vehicle Information

Please tell us about your ability to travel to and from CASA events including visits and hearings. If you need transportation accommodations, please mark N/A with today's date in the following fields and provide requested accommodations in the field provided.

31. Driver's License Number (or N/A)*

32. Which state is your license issued by? (or N/A)*

33. What is the expiration date of your license? (or N/A)*

Example: January 7, 2019

34. Auto Insurance Company (or N/A)*

35. Expiration date of your auto insurance policy (or N/A)*

Example: January 7, 2019

36. If you need transportation accommodations, please tell us what would be helpful.

Education

Please tell us about your education background. There are no specific educational requirements to become a CASA.

37. Highest Education Level Completed*

GED

High School

Vocational Training

Some College

College Graduate

Post-Graduate

Do not know

Other

Other*

38. Major or Field of Study. Or mark "N/A"*

Employment

No specific employment experience is required to become a CASA. Sharing your employment experience helps us get to know you and can even help us make good matches with children and youth.

39. Please describe your profession, field of work, or field of study.

40. Which best describes your current employment status?*

Employed Full-Time (includes self-employment)

Employed Part-Time (includes self-employment)

Full-time Student

Part-time Student

Not employed

Not employed and seeking work

Retired

Do not know

41. Current Employer (or most recent employer if you are not currently working). Mark "N/A" if you've never been employed.*

42. Current or Most Recent Job Title (or "N/A")*

43. While no training or experience is necessary to become a CASA, please tell us about any other training you feel may be helpful to you in this volunteer capacity.

Welfare Experience

Please answer the following questions as completely as you can.

44. Please describe any interaction you've had with child protective services or child welfare agencies. Or mark "N/A"*

Volunteer Experience

You are not expected or required to have prior volunteer experience. But if you do, we'd like to hear about it.

45. Please describe other volunteer experience(s) you've had. You can consider community service, church or school volunteering along with other non-profit organizations. Or, write "N/A".

Personal Reference (1 of 4)

The first 3 references are required. The 4th is optional but can be helpful if we don't get a response from one of the others listed as we cannot approve you to the program before connecting with 3 people. We will collect reference information from the individuals you provide. Try to avoid relatives, and friends. For example, consider teachers/professors, co-workers, past or present employers, other people you volunteer with, etc.

46. First & Last Name*

47. Relationship to applicant*

48. How long have you known each other?*

49. Email Address*

Enter Email Confirm Email

50. Phone Number with area code

Personal Reference (2 of 4)

51. First & Last Name*

52. Relationship to applicant*

53. How long have you known each other?*

54. Email Address*

Enter Email Confirm Email

55. Phone Number with area code

Personal Reference (3 of 4)

56. First & Last Name*

57. Relationship to applicant*

58. How long have you known each other?*

59. Email Address*

Enter Email Confirm Email

60. Phone Number with area code

Personal Reference (4 of 4 - Optional)

61. First & Last Name

62. Relationship to applicant*

63. How long have you known each other?*

64. Email Address*

Enter Email Confirm Email

65. Phone Number with area code

Personal Narrative

Much of the a CASA's advocacy is done through written communication. Help us get to know you better in your written responses to the following prompts.

66. Briefly explain what role you believe individuals within a community should play in helping a family overcome hardships and remain living together as one unit.*

67. Why do you want to be a CASA volunteer?*

Application Agreements

I attest that the statements on this application and any screening documents are true, complete, and correct to the best of my knowledge. I understand that falsification of this application and any screening documents can disqualify me from consideration or can result in dismissal at a later time.

I understand that, as part of the ongoing screening process, I will provide consent to the CASA program and other appropriate agencies to secure a background check including, but not limited to:

Criminal records from the court jurisdiction in which the applicant currently resides and works.
State criminal records.
FBI or other national criminal database.
National sex offender registry.
Child abuse registry or child protective services where permissible by law.
Social security number check of the equivalent that allows for additional names, aliases, and/or addresses to be obtained for the individual for further checks.

I understand that acceptance to, and completion of, pre-service training does not ensure that the applicant will be approved into the program and assigned to casework.

I also understand that if, for any reason, it becomes apparent that my activities are contrary to the policies, goals and/or philosophy of the CASA program and their desire to provide quality services to abused and neglected children, my services as a CASA volunteer will be terminated.

Certify*

I agree to and accept the terms and conditions above.

68. My typed name below indicates my agreement with the above statements.*