Monroe County CASA
Volunteer Application
Download Blank
Application
Page 1 of 8
Qualifications and Personal Information
Please correct the following errors:
Qualifications
Are you 18 years old, but less than 21 years old?
YES
NO
*
Are you 21 years old or older?
YES
NO
*
Are you applying for a position as a Child Visit Monitor (CVM)?
YES
NO
*
Are you applying to become a CASA Volunteer?
YES
NO
*
Personal Information
First Name
*
Middle Name
*
Last Name
*
SSN
*
AKA
*
Address
*
Address 2
*
City
*
State
*
Zip
*
County
<<None selected>>
Adams
Allen
Bartholomew
Benton
Blackford
Boone
Brown
Carroll
Cass
Clark
Clay
Clinton
Crawford
Daviess
Dearborn
Decatur
DeKalb
Delaware
Dubois
Elkhart
Fayette
Floyd
Fountain
Franklin
Fulton
Gibson
Grant
Greene
Hamilton
Hancock
Harrison
Hendricks
Henry
Howard
Huntington
Jackson
Jasper
Jay
Jefferson
Jennings
Johnson
Knox
Kosciusko
LaGrange
Lake
LaPorte
Lawrence
Madison
Marion
Marshall
Martin
Miami
Monroe
Montgomery
Morgan
Newton
Noble
Ohio
Orange
Owen
Parke
Perry
Pike
Porter
Posey
Pulaski
Putnam
Randolph
Ripley
Rush
Scott
Shelby
Spencer
St. Joseph
Starke
Steuben
Sullivan
Switzerland
Tippecanoe
Tipton
Union
Vanderburgh
Vermillion
Vigo
Wabash
Warren
Warrick
Washington
Wayne
Wells
White
Whitley
*
Gender
Male
Female
Other/Decline
*
Hispanic
Race
<<Select a value>>
African American or Black
American Indian or Alaska Native
Asian American
Caucasian or White
Multi-Racial
Native Hawaiian/Other Pacific Islander
Other
Unknown
Birthdate
Open the calendar
*
Birth City
*
Birth State
*
Home Email
*
Work Email
*
Home Phone
*
Cell Phone
*
Work Phone
Best Phone
<<Select a value>>
Home
Cell
Work
*
Marital Status
<<Select a value>>
Divorced
Domestic Partnership
Engaged
Married
Single
Unknown
Widowed
Primary Language
<<Select a value>>
American Sign Language
Arabic
Chinese
English
French
German
Japanese
Russian
Spanish
*
Additional Language...
Language
Add Education...
Type
Degree
Major