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Application
Review
Instructions

Please complete the following fields in the form below.

First Name
Last Name
MI
Street Address
Apt.
City
State
Zip
County
Gender


Date of Birth
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Home Phone
Cell Phone
Work Phone
Email Address
Emergency contact (name)
Emergency contact (phone)
Education
Ethnicity
Other Language
Place of employment or school
Referred by
Other

Please provide one professional, one personal and one family reference.

Reference Number 1

1. Name
Relationship
Address
Apt.
City
State
Zip
Email
Phone
Reference Number 2

2. Name
Relationship
Address
Apt.
City
State
Zip
Email
Phone
Reference Number 3

3. Name
Relationship
Address
Apt.
City
State
Zip
Email
Phone
Questions

Why do you wish to become a CASA Volunteer?
Describe any experiences you have had with the child welfare, foster care or juvenile court systems.
Describe your previous volunteer experiences
Have you ever had a volunteer application rejected?


Explanation
Have you ever been asked to leave a volunteer program?


Explanation
Do you have a police record (including DUI)?


Date of Offense
Have there ever been allegations made against you for child abuse/neglect?


Outcome:
Will your work schedule permit your attendance at court during the day?


Are you willing to make a one year commitment?


Are you willing to travel outside of Anne Arundel County?


Certification Agreement

Submission of this electronic application certifies that it contains no willful misrepresentation or falsifications and that this information given by me is true and complete to the best of my knowledge and belief. I am aware that should investigation at any time disclose any misrepresentation or falsification, my application will be disapproved. I understand that my completed application hereby becomes the property of Anne Arundel County CASA, Inc. (AACCASA).

I understand the sensitive nature of the work of a CASA volunteer and, therefore, give my consent to AACCASA 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
  • National Sex Offender Registry 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.

Application
Review
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