Advocate Application Form

If you’re interested in volunteering with us as an advocate, please fill out the form below!

"*" indicates required fields

Step 1 of 8

Name:*

First Last

Birthdate:*

MM slash DD slash YYYY

Mobile Phone:

Home Phone:

Email:*

Address:*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Name:*

Emergency Contact Phone:*

How long have you lived at your current address?*

Please list any out-of-state address you've lived, including the county of residence.

Employer Information

Employer:*

Occupation:

If you are not currently employed, please indicate your employment status (retiree, student, parent, etc.) in the EMPLOYER field and indicate N/A in remaining fields.

Supervisor Name:*

Phone:

Address:

Street Address Address Line 2 City State ZIP Code

Personal Information

Education:*

School

Degree Earned

Do you speak a language other than English?*

Yes

Please describe any current and previous volunteer experience over the last five years:

We are always looking to share CASA's mission locally, please list any personal and/or professional organizations you are affiliated with (i.e. local corporations, businesses, foundations, professional or civic groups, social or service groups, networking groups, churches, etc.)*

Hobbies:

What strengths do you feel you will bring to this program?*

How did you learn about Henrico CASA?*

Personal Information

Have you ever worked with another CASA Program?*

Yes

Will you be able to complete the required CASA pre-service training? (36 total hours + 3 hours courtroom observation?)*

Yes

As a CASA volunteer, will you be able to participate in ongoing training?*

Yes

As a CASA volunteer, will you be able to attend court appearances?*

Yes

Will you be able to make a one-year commitment to CASA?*

Yes

As a CASA Volunteer, you will need computer skills to prepare and submit reports.

Do you have access to a computer?*

Yes

Are you skilled in the use of Microsoft Word?*

Yes

Do you have an email account?*

Yes

Writing Sample

Writing Sample Upload*

Max. file size: 200 MB.

A CASA advocate is required to prepare a written report for the court. Please provide a writing sample of 500 words or less, in English, to address why you would like to volunteer with Henrico CASA at this point in your life.

References

Please list 3 references of people unrelated to you who know you well, preferably people for whom you have worked either in a paid or unpaid capacity.

Reference 1 Information:

Reference Name:

Reference Email:

Reference Phone:

Reference Address:

Street Address Address Line 2 City State

Reference 2 Information:

Reference Name:

Reference Email:

Reference Phone:

Reference Address:

Street Address Address Line 2 City State

Reference 3 Information:

Reference Name:

Reference Email:

Reference Phone:

Reference Address:

Street Address Address Line 2 City State

Background Checks

Do you have any court cases pending in Henrico County?*

Yes

Do you have any court cases pending in any court?*

Yes

Please disclose all criminal/legal offenses of which you have been charged as an adult or juvenile and the disposition of these offenses:

Will you grant the program the authority to follow up on this information?*

Yes

This information may or may not preclude you from becoming a volunteer, but the information will be considered. NOTE: Your application will be rejected if you have been convicted of, or have charges pending for a felony or misdemeanor involving a sex offense, child abuse or neglect, or related acts that would pose a risk to children or the CASA program's credibility.

I understand that by submitting this application I authorize inquiries to be made concerning my employment and character for the purpose of determining my suitability as a volunteer. I further understand that by my signature on this application, I authorize Henrico CASA and other appropriate agencies to secure an FBI fingerprint check or national criminal database check, state criminal check, and local criminal check where the applicant resides and works, national sex offender registry check, motor vehicles division record check with a Social Security Number verification, and local child protective services check as appropriate and permissible by Virginia State. If the applicant has lived in another state within the past seven years, Henrico CASA will conduct a child protective services record check and a criminal record check in that county and state where allowed by law. All information will be held in strictest confidence. Henrico CASA is required to re-screen volunteers every four years.

Criteria used in the selection of volunteers will be such as to ensure that the individual is able to meet the responsibilities of Court Appointed Special Advocate.

E-Signature*

By providing your name in this field, you are agreeing to have this text represent your signature. *By submitting this volunteer application you are consenting to receive Henrico CASA's electronic newsletter and other Henrico CASA communications relevant to our mission.

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

There are many ways to help!