CASA® Volunteer Applicant Reference Form
Lucas County CASA/GAL Department
Lucas County Juvenile Court
1801 Spielbusch Ave.
Toledo OH 43604
Phone: 419-213-6753
Fax: 419-213-6785
Judge Denise Navarre Cubbon
Judge Connie Zemmelman
CASA/GAL Director, Judith A. Leb
CASA Applicant's Name *
Your answer
Today's Date *
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Your Name *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Telephone *
Your answer
E-Mail *
Your answer
How well do you know the CASA Applicant? *
I know the CASA Applicant as a: *
(Check all that apply)
Required
To my knowledge, the CASA Applicant *
If needed, explain your answer in the comments section below.
To my knowledge, the CASA Applicant *
If needed, explain your answer in the comments section below.
The CASA Applicant has good people skills. *
If needed, explain your answer in the comments section below.
The CASA Applicant will keep information confidential. *
If needed, explain your answer in the comments section below.
The CASA Applicant respects cultural diversity and will work well with people of different races, people of the opposite sex, people with disabilities or people with religious views differing from his/her own. *
If needed, explain your answer in the comments section below.
The CASA Applicant relates well to children. *
If needed, explain your answer in the comments section below.
The CASA Applicant possesses good common sense. *
If needed, explain your answer in the comments section below.
The CASA Applicant will behave in a professional manner at all times. *
If needed, explain your answer in the comments section below.
Check any or all below that describe the CASA Applicant's temperament. *
If needed, explain your answer in the comments section below.
Required
How well does the CASA Applicant finish projects and/or activities? *
If needed, explain your answer in the comments section below.
Do you consider the CASA Applicant to be emotionally stable? *
If needed, explain your answer in the comments section below.
How would you rate the CASA Applicant's ability to be objective and non-judgmental of other's behavior or lifestyles? *
If needed, explain your answer in the comments section below.
CASA volunteers are highly visible to the public. They deal extensively with children and with confidential matters regarding child victims and their families. Please explain any concerns or other issues that you feel might impact on the CASA Applicant's effectiveness in the comments section below.
YOUR COMMENTS: (The box will expand.)
Your answer
I am interested in learning more about becoming a CASA volunteer. Please send me information.
Thank you for taking the time to complete this reference. Your interest in the welfare of our community's abused and neglected children is appreciated.
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