Voices for Children - CASA of the Brazos Valley > Volunteer

Volunteer Application

Click here to complete and submit a Volunteer Application on-line.

First Name:	Last Name:
Date of Birth:
Address:	City, State	Zip code
Home Phone:	Work Phone:	Cell Phone:
Email:
In case of an Emergency, contact:	Phone Number:
Marital Status
Level of Educaton/Degree:
Place of Employment:	How Long:
Employment Address:
Position:	Supervisor:
Language Spoken:	Degree of Fluency:
EXPERIENCE:
Do you have any experience working with children? YesNo
If yes, please describe: (type of activity/ages of children/professional or volunteer?)
Have you ever applied with another organization that works with children? YesNo
Were you accepted? YesNo
What were your responsibilities?	Name of Organization
Please list any organizations you are currently involved with/member of:
Have you ever applied to this or any other CASA in the past? YesNo
If yes, when and where:
Do you give CASA of Brazos Valley permission to obtain information from the agency(s) or Club(s)'s regarding your previous volunteer experience and membership? YesNo
If no, please explain:
Do you have any personal or professional/volunteer experience with the following?

Child Abuse: YesNo
Foster Care: YesNo
Child Protective Services: YesNo
Criminal, Juvenile, or Family Court: YesNo
Other child service agencies: YesNo
If yes to any of the above, please explain:
Please complete all questions and provide details as needed:
1. Are you now receiving or have you ever received mental health treatment? YesNo
If yes, please explain:
2. Have you ever been charged and/or convicted of a misdemeanor? YesNo
If yes, please explain:
3. Have you ever been charged and/or convicted of a felony? YesNo
If yes, please explain:
4. Have you ever been or are you currently on probation and/or parole? YesNo
If yes, please state the offense and the beginning/end dates of probation/parole:
5. Do you now or have you ever had a chemical or alcohol dependency/abuse problem? YesNo		Does anyone in your family? YesNo
If yes, please explain:
6. Are you currently receiving or have you ever had treatment for chemical or alcohol dependency/abuse? YesNo		Has anyone in your family? YesNo
If yes, please explain:
Please include dates of treatment and length of sobriety:
7. Do you have any kind of health impairment that would prevent you from performing CASA duties? YesNo
If yes, please explain:
8. Have you ever been charged or convicted of sexual misconduct (including pornography)? YesNo
If yes, please explain:
9. Do you give CASA of Brazos Valley permission to obtain additional information for screening purposes from other sources? YesNo
As a CASA volunteer, will you be willing to:
Commit a minimum of one year to being a CASA Volunteer. YesNo
Attend all hearings and meetings on your case when scheduled. YesNo
Participate in CASA's initial training program of 30 to 35 hours. YesNo
Participate in ongoing training with CASA to equal 12 hours a year. YesNo
Visit with the child(ren) in their placements a minimum of once a month. YesNo
Participate in fact finding, monitoring, and report your knowledge orally and in written form. YesNo
Do you agree that your first six months in the CASA program are probationary? YesNo
Do you agree to maintain liability insurance for your vehicle throughout your program participation? *Please bring proof of insurance to interview. YesNo
Please list five personal references (NOT related to you), that we can contact as a character reference.
1. Name:	Phone:
Address:	Email:
2. Name:	Phone:
Address:	Email:
3. Name:	Phone:
Address:	Email:
4. Name:	Phone:
Address:	Email:
5. Name:	Phone:
Address:	Email:
Essay Questions Please answer the following questions below. There are no right answers to these questions, but provide us with insight into your background and desires for volunteering.
Please write a brief autobiography. Be sure to include any historical information you feel especially shaped your life. Include information about your childhood, current family, and currect lifestyle, such as career, hobbies, interests, etc.
Please provide a short summary about your interest in volunteering with Voices for Children, Inc.
ACKNOWLEDGEMENT AND DECLARATION: "I am interested in becoming a volunteer, and know no reason why I should not be assigned to a child in the program. I am aware that the children in the program have been abused, neglected or abandoned by adults, and since I do not want to be another cause of disappointment to the child, I agree to a minimum commitment of one year to the child(ren) and case to which I am assigned." THE UNDERSIGNED ACKNOWLEDGES AND AGREES THAT: 1. CASA retains the right to refuse any individual that it feels would not be in the best interest of the program and, further, CASA is not required to state the reason(s) for non-acceptance, and that 2. The volunteer's file is held in strictest confidence and becomes the property of Voices for Children, Inc., CASA of Brazos County.
By checking "Yes" and submitting this form, I am agreeing that I have truthfully responded to all of the questions on this application.* YesNo
***A Release of Information Form will be need to be signed at your interview. A CASA program does not accept applicants if they, or an immediate family member, have been convicted, or have prior charges, or have charges pending for a felony or misdemeanor involving a sex offense, violent act, child abuse or neglect, delivery of illegal drugs or related acts that would pose risk to children or the CASA program's credibility.
Equal Opportunity Statement: It is the policy of Voices For Children, Inc., CASA of Brazos County to implement affirmatively equal service to all clients without regard to race, religion, sexual orientation, group, age, gender or national origin.
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Voices for Children Social Media

115 N. Main
Bryan, TX 77803
Phone: (979) 822-9700
Fax: (979) 822-9777

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