Skip to main content

Become a Volunteer

Apply

Personal Information
Name:
Address:
City:
State:
Zip:
Phone:
Date of Birth:
/
/
Occupation:
Spouse's Name (if applicable):
Emergency Contact:
Phone:
Ethnicity:
Do you speak other languages besides English?
If so, which ones?

 

 


 

Education
High School Attended:
Grade Completed:
College/Trade School:
Years Attended:
Degrees/Training Received, Subjects Studied:

 

 


 

Employment Experience
Present Employer:
Phone:
Address:
Job Title:
Type of Work:
How long have you worked at your present job?

 

 


 

Previous Employer:
Phone:
Address:
Job Title:
Type of Work:
How long did you work at this job?

 

 


 

 

 

Background Information
Have you ever been arrested for any criminal offenses other than minor traffic violations?
If yes, please explain:
Current Criminal Charges?
Are there any criminal charges pending against you at this time?
If yes, please explain:

Please be aware that the CASA program may reject an applicant found to have been convicted of, or having charges pending for a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose risks to children or the CASA program’s credibility.

 

 


 

 

 

PLEASE COMPLETE THE FOLLOWING QUESTIONS:
Are you employed?
If so, please describe your work hours and flexibility. (Remember, you may have to visit your children, talk to professionals and visit schools during the weekday.)

 

 


 

Rank Your Skills (1 = Low; 5 = High)
Typing/Computer
Ability to analyze situations
Writing Skills
Verbal Skills
Self Motivation
Confidence
Flexibility
Organization
Reliability
Common Sense
Persistence
It is mandatory to have an answering machine/voice mail. Do you have one?
When is the best time to reach you?
Do you have access to a computer?
Can you meet the 35-hour training program requirement?
If you are accepted into the program, are you willing to make a minimum of a 24-month commitment, (barring any unforeseen circumstances such as illness or a move) to Winnebago County CASA, including an annual requirement of 12 hours of in service time and scheduled court hearings?

 

 


 

References

APPLICANT:

PLEASE LIST THREE REFERENCES
: (Furnish complete information) (No family members)

Please include one employer if applicable.

1. Name:
Phone:
Address:
City:
State:
Zip:
Occupation:
How long have you known this person?

 

 


 

2. Name:
Phone:
Address:
City:
State:
Zip:
Occupation:
How long have you known this person?

 

 


 

3. Name:
Phone:
Address:
City:
State:

 

Acceptance into program will not be final until all references are received.


 

State:

Making everlasting change starts with one child at a time.

Our Impact This Year

  • Children Helped in 2017

    336

  • Volunteer Hours

    2,600

  • Dollars Raised

    $10000

  • Program Participants

    115

© 2018 Winnebago County CASA Program

Powered by Firespring.org