CASA Volunteer Application

Submitted by admin on Wed, 11/15/2017 - 16:10

Please fill out the form below completely including the Release of Information section. You may also print the form and fax to 937-224-3693 or mail to: Montgomery County Juvenile Court CASA/GAL Program, 380 West Second Street 2nd Fl., Dayton, OH 45402.

Note: If you have trouble proceeding with the application, please make sure all fields are completed.

  • 1 Section I - Application
  • 2 Section II - References
  • 3 Complete
State/Province
Have you lived in another state in the past 5 years?

 

 

 
Employment status
Do you hold a valid Ohio Driver's License?
Are you willing to travel locally to make contacts and obtain information?
Do you have flexibility with daytime work hours?
May we call you at work?
May we email you at work?

 
Have you been or are you currently a foster parent?

 
Do you have a prior history with any Child Protective Services Agency?

 
Have you ever been involved with the Juvenile Justice System?

 
Have you applied to or been involved with another CASA/GAL program in Ohio or another state or U.S. territory?

 

 
Have you ever been convicted of a crime related to children or involving violence?

Statistical information required for grant purposes and to assist in matching a child's needs:
 
Ethnicity
Education
Primary Language
Secondary Language

 

Note: If you have trouble proceeding with the application, please make sure all fields are completed