CASA of West Central Illinois Volunteer Application
Thank you so much for your interest in becoming a CASA! Please read through this form and fill it out carefully and completely to the best of your availability. We will be in contact with you shortly after receiving your application.

This form does not save your answers, so please fill it out in one sitting, or keep a copy of your answers in another document.

If you would prefer to fill out a hard copy of this application, please contact kradeke@casaofwestcentralillinois.com.  
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What is today's date? *
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Name *
Street Address *
City *
State *
Zip Code *
Home Phone *
Work Phone
Cell #
Fax #
Email Address *
Occupation *
How long have you been at current job? *
Place of Employment (If retired or unemployed, please list above information for last place of employment) *
Do you work part-time or full-time? *
Required
May we call you at work? *
Emergency Contact (Name) *
Emergency Contact (Phone Number) *
Please indicate highest level of education completed *
Major/Minor *
Degree *
Name of School/University *
How did you hear about CASA of West Central Illinois? *
Do you have any training or experience in any of the following? *
Required
Please explain your background in any areas you may have checked off.
Please list your community activities and memberships in clubs, religious and professional groups, and other organizations. *
Languages Spoken *
Special Interests/Hobbies *
Have you ever been arrested? *
If yes, on what charge? (This program cannot accept any 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 this program’s credibility.) *
What do you feel are your strengths/weaknesses, especially in terms of being an advocate? *
Please describe any experiences you may have had with child abuse, neglect, the Juvenile Court system, foster care, the Department of Children & Family Services or any other related agencies which offer services to children. *
Write a brief (about 4 or 5 sentences) statement on why you have chosen to work with the CASA Program at this time in your life? *
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