Skip to main content

Volunteer Application

District Volunteer Application

Notice of Screening Procedures

In order to protect children and provide the court with qualified volunteers, a fingerprint-based national criminal history record investigation will be conducted on every applicant, as well as screening through the Department for Children & Family (DCF) Child Abuse and Neglect Central Registry.

The Office of Judicial Administration will submit the applicant's fingerprints to Kansas Bureau of Investigation (KBI) for a Criminal History Record Inquiry. The KBI will provide a report on the applicant's criminal record investigation to the Office of Judicial Administration. Applicants found to have been convicted of, or charges pending for, a felony or misdemeanor involving sex offense, child abuse or neglect, or related acts that would pose risks to children or the CASA program's credibility will not be approved for service. Applicants who do not provide fingerprints for criminal history background checks will not be approved to serve as a CASA.

The applicant's local CASA program will make inquires to the DCF Child Abuse and Neglect Central Registry and registries of other states where the applicant has lived in the past five years. If it is found that DCF or a similar agency in another state lists the applicant as the perpetrator of an act of child abuse or neglect the CASA program will generally disallow certification.

All information will be held in strict confidence. Criteria used in the selection of a volunteer will be such as to ensure that the individual is able to meet the responsibilities of a CASA. NO INDIVIDUAL WILL BE REJECTED BECAUSE OF RACE, COLOR, RELIGIOUS CREED, NATIONAL ORIGIN, ANCESTORY, GENDER, AGE, DISABILITY OR MARITAL STATUS.

Applicant Information
First Name *
Middle
Last Name *
Preferred Name
Month
/
Day
/
Year
Phone Number(s)
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Work/Volunteer History

Present Employer/Volunteer Agency

Country
Address Line 1 *
City *
State/Province *
Postal Code *
Company/Organization Phone
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year

Previous Employment/Volunteer Agency

Company/ Organization Name
Country
Address Line 1
City
State/Province
Postal Code
Company/Organization Phone
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year

Previous Employment

Country
Address Line 1
City
State/Province
Postal Code
Company/Organization Phone
Start Month
/
Start Day
/
Start Year
-
End Month
/
End Day
/
End Year
Education/ Training
Do you have any experience in a related area?
Legal History

Note: It is important that you be thorough and honest in giving these answers. Answers which are found to be untrue may disqualify you as a potential volunteer.

Personal References

Please print names, addresses, and phone numbers of people who have known you for at least two (2) years, who know you well, can address how you relate to children and others, and how well you could fulfill the responsibilities of a CASA volunteer. The CASA program staff will contact the references you list. DO NOT INCLUDE RELATIVES.

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
Emergency Contact
First Name *
Last Name *
Country
Address Line 1
City
State/Province
Postal Code
Close