Boston CASA Volunteer Application

Date *

Date

How did you learn about Boston CASA?

I attended a information session on Add date of session* .

Name *

First Name Middle Name Last Name

Date of Birth *

Date

Preferred Phone *

Area Code Phone Number

Preferred Phone Type

Other Phone

Area Code Phone Number

Other Phone Type

Address *

Street Address

Street Address Line 2

City State

Zip Code

E-mail *

Employer *

Occupation/Field of Study

Does your employer have a matching gift program? *

Emergency Contact: *

Relationship: *

Emergency Contact Phone:

Area Code

Emergency Contact Phone *

Area Code Phone Number

Are you Bi-lingual? If yes, please list language(s) below:

Professional Licenses/Certifications

Educational Background

Employment Status

I Identify my gender as: (This information is gathered for internal use only and is intended to be used for funding and other reporting requirements) *

Female Male Genderqueer/Non-Binary Prefer not to Disclose Transgender

Please share your pronouns:

Do you identify as a member of the LGBTQ+ community? (This information will be confidential and used for funding data reporting) *

Yes No Prefer not to Disclose

Are you Hispanic or Latino? (This information will be confidential and used for funding data reporting) *

Yes No Prefer not to Disclose

How do you identify? (This information will be confidential and used for funding data reporting) *

American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Prefer not to Disclose

Have you had any professional and/or personal experience involving the following? (we will discuss further in the interview)

Court System Child Welfare Foster Care Child Care

Have you lived outside of Massachusetts? If yes, please tell us where:

Work Experience (if you prefer, you may submit a resume to charly@bostoncasa.org):

Please list current & previous volunteer experience (including past experience with the CASA program):

Why are you interested in volunteering as a CASA (Guardian ad Litem)? *

Do you have any reservations about becoming a CASA volunteer that you would like to share with us? *

What motivates you to want to volunteer for Boston CASA? What do you expect to gain from this experience? What do you believe you will bring to the program? *

The children served by Boston CASA have experienced abuse or neglect most often due to a combination of factors such as parental mental illness, domestic violence, substance abuse, and poverty. As much as you are willing to share, describe your personal or professional experience with these various issues. How do you expect that your experience, or lack thereof, will influence you as a CASA? *

Please list two people below who can provide a reference for you. One reference needs to be a current or past supervisor and the other a colleague or friend (but not a family member).

Name *

Email Address *

Name *

Email Address *

To the best of my knowledge the above information is true and is submitted voluntarily. This information may be used and disclosed for Boston CASA purposes and I realize that as a CASA Volunteer, I will not be paid for my service. I am aware that Boston CASA has the right to release me from service at any time, just as I have the right to withdraw from volunteer service at any time.

Signature:

Clear

Today's Date: *

Date

At Boston CASA, we don’t just accept difference - we celebrate it, support it, and thrive on it for the benefit of our team and the communities we serve. Boston CASA is an equal opportunity employer and as such, we do not discriminate against any team member or candidate because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy, or any other basis protected by law. We encourage all to apply because we believe a diversity of voices leads to better discussions, decisions, and outcomes for everyone.

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I Identify my gender as:

Female Male Genderqueer/Non-Binary Prefer not to Disclose

How do you identify?

American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White Prefer not to Disclose