Volunteer Application

Boston CASA Volunteer Application
Date*

MonthDayYear
Date
How did you learn about Boston CASA?
I attended a information session on Add date of session* .
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Preferred Phone*

Area CodePhone Number
Preferred Phone Type
Other Phone

Area CodePhone Number
Other Phone Type
Address*

Street Address

Street Address Line 2

CityState

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 CodePhone 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)*

FemaleMaleGenderqueer/Non-BinaryPrefer not to DiscloseTransgenderOther
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)*

YesNoPrefer not to Disclose
Are you Hispanic or Latino? (This information will be confidential and used for funding data reporting)*

YesNoPrefer not to Disclose
How do you identify? (This information will be confidential and used for funding data reporting)*

Native American or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhitePrefer not to DiscloseTwo or More RacesOther
Have you had any professional and/or personal experience involving the following? (we will discuss further in the interview)

Court SystemChild WelfareFoster CareChild Care
Have you lived outside of Massachusetts? If yes, please tell us where:
I understand and am willing to travel to visit the youth I am assigned 1-2 times a month. Boston CASA staff will do their best to match volunteers to youth close by, but travel time of at least 30 minutes by car and 45 minutes by public transit is expected. These times can be longer depending on CASA or youth location. Youth may move frequently during your time as a CASA.

YesNo
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 or another professional contact and the other a colleague or friend (but not a family member).
Reference Name*
Reference Email Address*
Reference Name*
Reference Email Address*
I represent that the above information is submitted voluntarily and, to the best of my knowledge, true in all respects. I understand that this information may be used and disclosed for Boston CASA purposes. I further understand that if I become a CASA Volunteer, I will not be paid for my service or be construed as an employee of Boston CASA. Acceptance into the Boston CASA Volunteer Program is determined based on the needs of the organization and is contingent on successfully completing all training requirements to the standard required by National CASA and Boston CASA expectations. I understand that Boston CASA or I may end my volunteer services at any time and for any reason.

All volunteers will have to consent to a state and federal background check, social security check and a DCF background check during training. These background checks will be run throughout your time as a volunteer.
Signature:

Clear
Today's Date:*

MonthDayYear
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:

FemaleMaleGenderqueer/Non-BinaryPrefer not to DiscloseOther
How do you identify?

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhitePrefer not to Disclose
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Boston CASA Volunteer Application