Please complete the following application form and click on the submit button. Once your completed application is received, we will contact you for an interview. If you are not contacted within seven days, contact Kathy at (208) 345-3344. All information provided on this form will be used only for the volunteer application process of becoming a Guardian ad Litem.

The following is an on-line application that will be forwarded to our CASA department. Upon receipt, you will be contacted with further instructions. You will get an email copy of your submission.

FAMILY ADVOCATE PROGRAM - IV JUDICIAL DISTRICT
CASA Volunteer Application

Full Name:
(Last, First, Middle, Maiden)
Other names used:
(Provide full name used, such as maiden name)
Street Address:
City, State & Zip:
Other states you have lived in during the past 5 years:
Home Phone:
Work Phone:
Cell Phone:
Other Phone:
Email Address:
DOB:
Are you employed? Yes No
May we contact you at work? Yes No
Employer:
Job Title:
Supervisor:
Nature of work:
Do you have a valid Idaho driver's license? Yes No
Do you have access to a car? Yes No
Have you ever been convicted or received a withheld judgment as an adult of any felony or misdemeanor which is a sex offense, a crime against moral turpitude, a crime affecting family relationships and children, assault, battery, or an attempt or conspiracy to commit any such offence? Yes No
Are you currently charged with a crime? Yes No
If you answered yes (to either question above), what is the crime you are convicted or charged with:
Date of conviction or charge:
Location (court):
Have you been involved directly with Social Services for any violation of the Child Protective Act? Yes No
If so, please explain:

REFERENCES: Please list three (3) people who are not related to you (At least one (1) must be a professional person.) As part of the Idaho CASA standards, these three people will be asked to provide a written reference.

Name	Address	Phone

Are there any facts not disclosed by your answers concerning your background, history, experience or activities which, in your opinion, may have a bearing on your character, fitness, or eligibility to be a Guardian ad Litem volunteer?
If so, please explain:

In clicking Submit below, I verify that the information provided herein is true an complete to the best of my knowledge. I understand that by submitting this application, I am authorizing inquiries and/or investigation of my criminal history to be made concerning my suitability as a volunteer Guardian ad Litem for children. I further understand that misrepresentation of this application form may be cause for disqualification of my application or dismissal of my volunteer work.

Family Advocate Program

Keeping Children Safe & Families Strong

FAMILY ADVOCATE PROGRAM - IV JUDICIAL DISTRICT
CASA Volunteer Application

Family Advocate Program

Keeping Children Safe & Families Strong

FAMILY ADVOCATE PROGRAM - IV JUDICIAL DISTRICT CASA Volunteer Application

FAMILY ADVOCATE PROGRAM - IV JUDICIAL DISTRICT
CASA Volunteer Application