Anne Arundel County CASA, Inc.
COURT APPOINTED SPECIAL ADVOCATE APPLICATION FORM

Dates: 
Received
How did you become aware of our program?
Contact Information:
Name:
Address:
City
Zip
County
Home Phone:
Work Phone:
Other
Email
Is it okay to contact you at work?  
Yes/No
General Information: 
Date of Birth
Age
Sex:
Male/Female
Marital Status:     
Married/Never Married/Divorced/Widowed/Other
Educational History: 
High School Degree
Yes/No
Highest Degree Obtained
Other
Fluent in any language other than English? (please list)
In Case of Emergency, Contact:
Name
Relationship
Phone Number(s)
Employment:
Status:    
Full-time/Part-time/Unemployed/Retired/Student
Occupation/Title
Place of Employment
Address
Phone #
Days/Hours Of Work
Please Outline Work History (include dates):
Please Outline Volunteer History:
Dates
Name
Purpose
Activities of Organization
Special Skills and Hobbies:
Briefly list any experience you have in the following areas:
Child Welfare
Juvenile Court System
Foster Care
Please discuss why you wish to become a Court Appointed Special Advocate. (What attracted you to this particular program? How do you expect to benefit from this volunteer experience?)
CASA Volunteers are required to participate in a 35 hour certification training and monthly in-service training sessions. They are generally scheduled for weekday evenings and weekends. Please list any times that you are routinely NOT available:
CASA Volunteers will be expected to attend court hearings and other important meetings held during the day, from time to time. Will your schedule permit this?
Are you willing and able to make a one year commitment to a CASA position or until the completion of one assignment?
Are you able and willing to travel to perform CASA duties?
Please list any other names you have used (maiden, previous marriage, etc.)
Please list all states where you have resided as an adult
Do you have a Police Record? 
Yes/No
If yes, date/offense/outcome
Has there ever been any allegation of child abuse or neglect made against you?
Yes/No
If so, what was the outcome?
Has your application to a volunteer program ever been rejected?
Yes/No
If yes, please explain
Have you ever been asked to leave a volunteer program?
Yes/No
If yes, please explain
PLEASE LIST THE FOLLOWING REFERENCES:

NOTE: IT IS VERY IMPORTANT THAT THIS SECTION BE FILLED OUT COMPLETELY. CASA WILL ATTEMPT TO OBTAIN WRITTEN AND/OR VERBAL REFERENCES FROM THE PEOPLE THAT YOU LIST. INSUFFICIENT INFORMATION WILL RESULT IN A DELAY OF YOUR APPLICATION.  RELATIVES MAY NOT PROVIDE A REFERENCE.
1. Professional:
Name
Relationship
Address
City, State, Zip
Email
Phone(s)    
2. A Peer, Friend, Neighbor:
Name
Relationship
Address
City, State, Zip
Email
Phone(s)    
3. Other::
Name
Relationship
Address
City, State, Zip
Email
Phone(s)    
My signature below signifies that I have read and understood the following statements:
I certify that all of the information that is provided on this application is true and accurate. If the information is found to be inaccurate, I may be released from my duties as a Court Appointed Special Advocate. I understand that my completed application hereby becomes the property of Anne Arundel County CASA, Inc.

 
I understand the sensitive nature of the work of a CASA and, therefore, give my consent to Anne Arundel County CASA to make the following inquiries about my background to help determine my suitability as a Court Appointed Special Advocate.
  • FBI/Criminal Background Check
  • Reference Inquiries
  • Driving Record Check
  • Department of Social Service Check
AACCASA will reject any applicant found to have been convicted of, or having charges pending for a felony or misdemeanor involving a sex offense, child abuse neglect or related acts that would pose risks to children or the program's credibility.
Signature of Volunteer
Applicant Date
Or print and return this application to: CASA, 94 Franklin Street, Annapolis, MD 21401