Request a Courtesy CASA

If a child from your jurisdiction has been placed in Lane County and you would like to request support through a courtesy CASA, please complete the form below. Our Intake Coordinator will review the request and follow up as soon as possible. While we cannot guarantee assignment, we’ll do our best to help based on current volunteer capacity. If you have any questions or concerns, please contact our Intake Coordinator directly at waitlist@casa-lane.org.

CASA Name Program

Requesting Staff Name

Email Address

Phone

(###)

###

####

County of Jurisdiction

Child(ren) Information

Child(ren) Name

Child(ren) D.O.B.

Juvenile Case Number

Home/Facility where Child(ren) is placed

Placement First & Last Name

Placement Date

YYYY

Placement Phone

(###)

###

####

Placement Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

CASA and Supervisor Information

Primary CASA's Name

Phone

Country

(###)

###

####

Primary CASA's Supervisor

Phone

(###)

###

####

Caseworker Information

Jurisdictional County DHS Caseworker

Phone

(###)

###

####

Brief description of the dynamics of this case, including reason the child came into care

Advocate. Empower. Support.

Donate

volunteer