Become a Volunteer

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APPLICATION FOR CASA PROGRAM

*REQUIRED
Personal Information:
*REQUIRED
*REQUIRED
*REQUIRED
Home Phone
Work Phone
Cell Phone
Social Security Number

If married, spouse’s name and occupation:

Spouse's Name
Spouse's Occupation
Emergency Contact
Emergency Contact Phone
Current Employer
Highest Level of Education
Name of School
Course of Study

(An applicant having a charge or conviction for a crime involving a sex offense or child abuse or neglect 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 impact the credibility of the CASA Program will be considered on a case by case basis considering the time passed since the incident and the level of rehabilitation.)

Children
Additional Members of Household
Current Health Status

PERSONAL REFERENCES

(You should know these individuals for at least one year. Two should be known through your work, volunteer service or academics. One may be a personal reference, excluding a family member.)

Complete mailing addresses are required.

Reference #1
Reference #2
Reference #3

WORK / VOLUNTEER HISTORY

AFFIRMATION AND RELEASE

I,

, hereby affirm that all of the answers provided on my volunteer application are true. I hereby authorize CASA of Southwest Missouri to investigate my background to determine my fitness as a potential volunteer. I understand that I must pass a social security number verification, a national and state criminal background check, a National Sex Offender Registry check, a child abuse registry check and a criminal records check from my home court jurisdiction.

I understand that the information requested in this application will be used only for the purpose of determining suitability as a CASA volunteer.

Further, I understand that after the successful completion of my training, I will be expected to serve a minimum of TWO years in the CASA program. If unforeseen circumstances prevent me from fulfilling this obligation, I shall submit my written resignation to the program director with as much advance notice as possible. I shall make every effort to remain on the case until a new volunteer is found.

CASA provides equal volunteer opportunities to all qualified applicants in accordance with all applicable federal, state, and local laws. They will be considered for volunteer status without regard to race, color, religion, sex, national origin, age, disability status, or any other non-merit factor. Further, CASA advocates for all victims referred by the Court without regard to same.

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