Online Application Go backYour message has been sent DATE Warning How did you hear about the CASA program? TV Radio Website Other Warning FIRST NAME(required) Warning MIDDLE NAME Warning LAST NAME(required) Warning HOME TELEPHONE NUMBER:(required) Warning WORK TELEPHONE NUMBER:(required) Warning EMAIL ADDRESS:(required) Warning HOME ADDRESS:(required) Warning COUNTY:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning Mailing Address Same as home address Warning MAILING ADDRESS:(required) Warning COUNTY:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning EMPLOYER: Warning POSITION/TITLE: Warning Work Full-time Part-time Seasonal Warning Length of employment: Warning WORK ADDRESS: Warning CITY: Warning STATE: Warning ZIP: Warning Please check the highest level completed: Some High School Post-Graduate High School Masters or Doctorate Some College College Graduate Warning Do you speak a foreign language? Yes No Warning Language(s): Warning Child care Warning Mental Health Warning News/Media Warning Law Warning Drug/alcohol Warning Child Development Warning Counseling Warning Writing/editing Warning Arts/graphics Warning Advertising Warning Child Welfare Warning Psychology Warning Public speaking Warning Public Relations Warning Social Work Warning Medicine Warning Education Warning Fund raising Warning Criminology Warning Please describe experiences checked above and share information about other volunteer service experiences: Warning Have you ever worked for juvenile court? Yes No Warning Have you ever worked for the Department of Family and Children Services? Yes No Warning Have you ever been a foster parent? Yes No Warning Have you ever sought treatment for a mental health problem? Yes No Warning Have you or any members of your family ever had a case with or investigation performed by the Department of Family & Children Services? Yes No Warning If Yes, please explain: Warning List any charges, arrests, and/or conviction(s) (pending or closed), other than traffic violations: (Provide dates,county, state, and disposition of each case. An applicant having a charge or conviction for a crime involving a sex offense, child abuse, neglect, or related acts that would pose risks to children or the CASA program’s credibility is disqualified as a CASA volunteer. Applicants with other misdemeanor or felony charges or convictions that would not pose a risk to children or negatively affect the credibility of the CASA program will basis considering the time passed since the incident and the level of rehabilitation.) Warning BEST TIME OF DAY: AM PM Warning BEST DAY OF WEEK: MO TU WE TH FR Warning OTHER: Warning Do you prefer to work with any particular age group? Yes No Warning Do you have access to transportation? Yes No Warning List any concerns you may have about the training requirements: Warning NAME:(required) Warning ADDRESS:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning TELEPHONE CONTACT(S):(required) Warning EMAIL:(required) Warning RELATIONSHIP:(required) Warning NAME:(required) Warning ADDRESS:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning TELEPHONE CONTACT(S):(required) Warning EMAIL:(required) Warning RELATIONSHIP:(required) Warning NAME:(required) Warning ADDRESS:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning TELEPHONE CONTACT(S):(required) Warning EMAIL:(required) Warning RELATIONSHIP:(required) Warning NAME:(required) Warning ADDRESS:(required) Warning CITY:(required) Warning STATE:(required) Warning ZIP:(required) Warning TELEPHONE CONTACT(S):(required) Warning EMAIL:(required) Warning RELATIONSHIP:(required) Warning Explain your interest in volunteering generally. Warning Explain why do you want to be a CASA volunteer and how do you hope to benefit from this volunteer experience. Warning Explain your philosophy for parenting, including the rights and responsibilities for both parents and children. Warning Explain what role do you believe society should play in protecting children versus assisting a family in overcoming hardships in order to function and ultimately live together as one unit? Warning Please write an autobiographical statement. Warning I agree Warning FULL NAME(required) Warning HOME ADDRESS(required) Warning CITY: Warning STATE: Warning ZIP: Warning SEX Male Female Warning DATE OF BIRTH (MONTH/DAY/YEAR)(required) Warning SOCIAL SECURITY NUMBER(required) Warning Please check one: African American Asian Caucasian Hispanic Other Warning If Other Specify : Warning Warning. Submit Δ Like Loading...
Clayton CASA 