CASA OF GALVESTON COUNTY
VOLUNTEER APPLICATION
CASA of Galveston County provide equal volunteer opportunities to all applicants without regard to race, color, religion,
sex, sexual orientation, national origin, age, disability, military status, or military veteran status in accordance with
applicable federal and state laws. In addition, CASA of Galveston County agrees to provide a volunteer environment that
is free of unlawful harassment of any kind including that which is sexual age-related or ethnic when the volunteer
environment is within CASA’s control
Court Appointed Special Advocates (CASA) of Galveston County
200 Texas Ave, Suite 641, Texas City, TX 77590 - Phone 409-572-2552 - Fax 409-572-2553
General Information
Date
Last Name
First Name
Address
Middle
Apt. #
City
State
Zip Code
How long have your live at this address?
If less than seven (7) years, please list your last address below:
Address
City
Apt. #
State
Zip Code
Home Phone:
Business Phone:
Mobile:
Can you be reached at work(circle) yes or no
Email:
Current Employer (if retired or unemployed list most recent employer)
Employer:
Work Address:
Immediate Supervisor:
Description of Work (full or part-time)
What languages do you speak other than English?
CASA of Galveston County
Volunteer Application
Revised April 2016
Demographic Information
Please check the appropriate box.
Marital Status
Race
Single
Married
Widowed
Divorced
Partner
African American/Black
Asian
White
American Indian
Alaska Native
Native Hawaiian
Other Pacific Islander
Ethnicity
Hispanic
Latino
Non-Hispanic/Latino
Education
High School Diploma
Some College
College Degree
Post Graduate
PHD/MD
Other
How did you hear about CASA?
Media
Name Source
Social Media
Name Source
Radio
Name Stations
Television
Name Station
Billboards
Name Location
Email
From Whom
Other
Name Source
References
Please provide three personal references with complete addresses where a reference questionnaire can
be sent. References from relatives are not acceptable. Personal letters are not accepted. Three
references must be completed and on file before the end of pre-service training and an assignment of a
case.
Reference #1
Name
Address
CASA of Galveston County
Apt.#
Volunteer Application
Revised April 2016
City
State
Zip Code
Company
Telephone number
Fax Number
Email address
Relationship to Volunteer Applicant
Reference #2
Name
Address
Apt.#
City
State
Zip Code
Company
Telephone number
Fax Number
Email address
Relationship to Volunteer Applicant
Reference #3
Name
Address
Apt.#
City
State
Zip Code
Company
Telephone number
Fax Number
Email address
Relationship to Volunteer Applicant
Required Security Screening
The CASA background check requires full disclosure of name changes, use of assumed names, nicknames,
etc. If you have used names other than the name provided above, please explain below.
Explain here:
Social Security Number
Driver’s License Number
Date of Birth
CASA of Galveston County
Place of Birth
Volunteer Application
Revised April 2016
Have you ever been convicted of a Crime?
Yes
No
If yes, please list the charges and explanation.
Essay Questions
Please answer the following questions below. There is no right answer to this question, but provide us
with insight into your background and desires for volunteering. You are welcome to answer these
questions on a separate piece of paper.
Please write a brief autobiography. Please be sure and include any historical information you feel
especially shaped your life. Include information about your childhood, current family, and current
lifestyle, such as career, hobbies, interests, etc.
Why do you want to volunteer for CASA of Galveston County?
What are some personal strengths that you bring to CASA?
CASA of Galveston County
Volunteer Application
Revised April 2016
Volunteer Acknowledgement Form
I hereby certify that the information submitted in this application is correct and accurate to the best of
my knowledge; and I authorize inquiries concerning my suitability as a CASA of Galveston County
volunteer. I understand that all the information will be held in strict confidence and used only for the
purpose of determining my suitability as a volunteer.
As a CASA volunteer, your primary focus is to advocate for the needs of the abused and neglected children
who are in the custody of Child Protective Services. Our volunteers collaborate with family members,
caseworkers, lawyers, therapists, and caregivers (foster parents, relative, etc.) to provide a
recommendation to the judge as to where the child will have a safe and permanent home. As such,
volunteers are expected to visit people involved with the child, attend court hearings, prepare court
reports and communicate with all involved in the child’s life during the legal process. Volunteers with
full-time jobs will have to be flexible with their time throughout their one-year commitment. I
understand that qualities of a successful CASA Program volunteer include interpersonal skills,
compassion, punctuality, and reliability. I further understand that if concerns arise, CASA Program
reserves the right to reject an applicant at any time, including after interviews, during the training process
or after certification.
I understand that all information provided to and obtained by CASA of Galveston County will be held in
the strictest of confidence. CASA of Galveston County may, however, disclose to other agencies and
organizations, which utilize volunteers, the fact that I applied for and/or served with the CASA Program
as a volunteer. Furthermore, all information obtained by CASA of Galveston County will be deemed to
be the sole property of the Agency, and shall not be available to me or anyone outside the Agency. I
understand and agree that I am not obligated if called upon to perform services of a CASA of Galveston
County volunteer and that CASA of Galveston County is not obligated to assign or actively seek to assign
a child to me.
As a CASA of Galveston County volunteer I will be willing to: (Please check the box for “Yes”)
Commit to a minimum of one year of service as a CASA volunteer
Participate in CASA’s 30+ hour volunteer training
Participate in 12 hours of continuing education training yearly
Visit in person with the child(ren) to whom I may be assigned at least monthly
Prepare written reports to the court with guidance from CASA staff
Participate and attend court hearings and meetings on my child’s case during business hours.
Record and turn in a monthly log of my activities on my case.
CASA of Galveston County
Volunteer Application
Revised April 2016
Please put an X next to the skills and/or other areas of interest listed below that you bring to CASA of
Galveston County.
Working with Children
Administrative
Telephone
Public Relations
Grant Writing
Fundraising
Social Media
Data Entry
Other
Signature of Applicant
Date Signed
Printed or Typed Name of Applicant
Social Security Number
CASA of Galveston County
Volunteer Application
Revised April 2016