Date of Inquiry *

Date information packet sent *

First Name *

Last Name *

Date of Birth *

(clear)

Home Address *

City *

State *

Zip *

Home Phone *

Work Phone

Email Address *

Is it okay to contact you at work? *

Yes No

Do you prefer to volunteer in the jurisdiction in which you live or work? *

Where I work Where I live

Have you ever volunteered with a CASA program in another jurisdiction in Maryland or in another state? *

Yes No

If yes, do you give permission for CASA of Baltimore, Inc to contact staff at that CASA program?

Yes No ( unselect )

Location of previous CASA program

Contact Person

How did you become aware of CASA of Baltimore?

VOLUNTEER APPLICATION PART I