Request a CASA

If you would like to request a CASA volunteer for a child in care, please fill out this form and we will contact you shortly. If you have questions, contact the Waitlist Coordinator at waitlist@casa-lane.org.

Name

First Name

Last Name

Email Address

Confirm Email Address

Phone

(###)

###

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Your Relationship To Child(ren)

Child Information

• Child's Name, Age & Court # (if known)* • Child #2's Name, Age & Court # (if known) • Child #3's Name, Age & Court # (if known)

Provide the following information if known:

• Location of the Children–Resource/Foster Parent Name, Address, Phone Number, and Date of Placement • ODHS Caseworker • Child's Attorney • Mother's Name • Mother's Attorney • Father's Name • Father's Attorney

Circumstances of the Case:

Please describe in detail the safety concerns you have for these children, as well as anything else that you think is important.

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