CASA Court Appointed Special Advocate Request Form
Please fill out as much information as you know about the child. Some items are required in order to submit your request for a child to be referred to the program. If you have any questions, please contact Volunteer Coordinator, Candace Waggoner at
Email *
Court Case Number
Next Court Date
Child's First and Last Name *
Child's D.O.B
Caregiver's Name
Caregiver's relationship to child
Caregiver's Phone
Caregiver's Email
Caregiver's Address
Sibling(s) to child listed above
Reason for Request *
Your First and Last Name *
Your Phone Number *
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