Volunteer Application (1299) "*" indicates required fields Step 1 of 8 12% CASA of the Portage County Volunteer ApplicationPlease fill out the application completely and we will be in contact with you shortly. Be advised that CASA of Portage is dedicated to diversity, inclusion and equity. 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 haven't reached yet.CAPTCHA Personal InformationEmail* Enter Email Confirm Email Name* First Middle Last Mobile Phone*Home PhoneWork PhoneBest Phone*Please selectHome PhoneWork PhoneMobile PhoneAre you at least 21 years old?* Yes No Date of Birth* MM slash DD slash YYYY Are you a U.S citizen?* Yes No Race*Select OneAfrican AmericanAmerican Indian/Alaska NativeAsianCaucasianMulti-racialOtherUnknownEthnicity* Hispanic/Latino Not Hispanic or Latino Please indicate your gender.* Female Male Non-binary Another option not listed here I prefer not to answer this question Address InformationHome Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Who all lives in your household and what is their relationship to you? Employment and ExperienceEmployment Status* Full Time Part Time Not Employed Retired Full-time Student Part-time Student Current Employer*Employer Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Highest Level of Education*Select OneAssociatesCollegeGEDHigh SchoolOtherPost-graduateSome collegeUnknownVocationalName of School*Degree Completed*Select OneAA/ASBA/BSMA/MSJD/PhDMajor/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.* How did you learn about the CASA program? Person Facebook Website Other CASA Program Other Check all that apply:Other, please specify:*Have you ever applied/or were you ever a CASA volunteer?* Yes No If yes, where/when?Do you have any current or prior history with any Child Protective Service Agency?* Yes No Is yes, please explain:*Do you have any past experiences, personally or professionally, with children's services or any juvenile court system?* Yes No Is yes, please explain:*Do you speak a second language?* Yes No If so, which one?*Are you applying to be fundraising board member?* Yes No Do you have a valid driver's license?* Yes No Have you ever been charged with or convicted of a crime in a court of law and/or have you ever had any protection or restraining orders filed against you?* Yes No Is yes, please explain:* 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 Portage?* Personal ReferencesPlease 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 CertifySubmitting 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.Certify* I agree to and accept the terms and conditions above.Name & Date