Please complete all sections. Fields marked with an asterisk are required.
Please provide 3 references. Include a minimum of 1 professional reference (i.e., supervisors, clergy, teachers, or therapists). We also ask that you choose 2 local references unrelated to you. Inform the people you list here to expect a reference form from our office. It should not take them more than 5 minutes to complete. Please advise them that you will not be assigned a child until the reference forms have been returned to our office. We verify all references.
I understand that by submitting this application, I am authorizing inquiries to be made concerning my suitability as a volunteer. This will include a background check for any criminal record. This information requested in the application will be used only for the purpose of determining suitability as a volunteer. If any applicant is found to have been convicted of or to have current charges pending for a felony or misdemeanor involving a sex offense, child abuse, or child neglect, that volunteer (by California rule 5.655) is automatically exempted from the role of CASA. All information will be held in confidence. I understand that all materials I submit become property of Modoc CASA Program and will not be returned.
I understand that volunteers are selected based on their individual ability to meet the responsibilities of the CASA Program. I also understand that because of the confidential nature of the screening process, this agency is not obligated to disclose to me reasons or sources for any decision concerning my acceptance or non-acceptance into the Program. Furthermore, I understand that the agency has to take the best interest of the children into consideration first when matching them with a CASA. Thus, I understand that in the event that I should complete the entire CASA training, (1) Modoc CASA Program is not obligated to certify me (present me to the Court to be sworn as an officer), (2) Modoc CASA Program is not obligated to assign, or to actively seek to assign to me a child, and (3) I am not obligated, if called upon, to perform volunteer services herein applied for. No individual will be rejected because of culture, disability, ethnicity, gender, marital status, national origin, race, or sexual orientation.
I understand that I must complete the minimum 30 hours of training that includes observing court proceedings before being considered for certification as a CASA volunteer. I further understand that I must participate in an additional 12 hours of in-service training each year. If selected for program certification and assigned to a child's case, I understand that my duties may include court appearances, visits to homes of family members involved in the case, and possibly visits to institutions or treatment programs.
Finally, I recognize that any changes made to this understanding must be made in writing and signed either by the Program Director or Executive Director.
