Volunteer Application

Application for CASA Program

Fill the required field

First Name
Last Name
Country
Address Line 1
City
State
Postal Code
May you be called at work?
Children:

First Name
Last Name
First Name
Last Name
Other Members of Household:

First Name
Last Name

Do you drive?
Do you have an automobile available to you?
When would you be available for volunteer service?
Check Times
Would you feel comfortable visiting with children in private homes, foster care homes, institutions, and/or group homes?
Are you prepared to complete CASA training and participate in ongoing continuing education?
Are you prepared to commit to the assigned case until permanency is achieved?
Are you prepared to commit time to participate in court hearings, team meetings, and case reviews?
Experience

Do you have any training or experience in any of the following?
Have you had any personal business or communication with the Tennessee Department of Children’s Services (DCS) or any other child welfare agency?
Have you ever been arrested for a crime, especially any crime in which children may have been involved?
Your Education (Check highest completed)

High School
College
Graduate
Work / Volunteer History:

Can you think of any reason Judge Beal might be reluctant to appoint you to the case?
Please describe here any experiences you have had working with children that are not included in your work/volunteer history above.
Personal References:

1.
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
2.
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
3.
First Name
Last Name
Country
Address Line 1
City
State
Postal Code
Name and Telephone #
AFFIRMATION AND AUTHORITY TO RELEASE INFORMATION

I,

, hereby affirm that all the answers provided on my volunteer application are true. I hereby authorize MADISION COUNTY CASA to investigate my background to determine my fitness as a potential volunteer. I understand that the information requested in this application will be used only for determining suitability as a CASA volunteer. If unforeseen circumstances prevent me from fulfilling this obligation, I will submit my written resignation to the program director with as much advance notice as possible. I am aware of the sensitive and confidential nature of the official document, reports, and other materials I will examine in my capacity as a volunteer CASA. I will discuss these matters only with those persons directly involved in the case or who will be consulted for their professional knowledge and expertise. I hereby authorize a representative of the CASA program to conduct an investigation on my background in conjunction with other official duties. This will include national, state, and local criminal records checks. At minimum the program will do a criminal records check with the Sheriff’s Department located in each county of residence for the past seven years nationwide; checks of the online databases for felony offender, sex offender, methamphetamine offenders, and abuse registry; and a fingerprint check through the Tennessee Bureau of Investigation and the Federal Bureau of Investigation. I further authorize any law enforcement agency to conduct a criminal record check and to release the results of said criminal record check to the CASA program. This release is executed by me with the full knowledge and understanding that the information to be obtained about me is for office use of the CASA program. In accordance with National CASA and Tennessee CASA standards, Madison County CASA must reject any volunteer applicant whose criminal records check shows a conviction for or pending charges of sexual offenses, child abuse or neglect, or related acts that pose a risk to children or to Madison County CASA’s credibility as a community service agency. “I have read the above waiver and release statement and fully understand what rights I am waiving by signing this document. I understand that I must complete a TBI/FBI Fingerprint Criminal Background Check prior to beginning training. I understand that the cost of this check is $40. I understand that I am responsible for full payment of this $40 at the time my fingerprints are taken.

Personal Info

First Name
Last Name
Sex:

*This information is required for the TBI/FBI Criminal Background Check.

Verification:

Example: 12
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