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Board Member Application

(CASA Program)
(Address)
Email and phone

Name: ____________________________________________

Phone: _________________________ Email: _________________________________

Mailing Address: ____________________________________City__________ Zip________

Occupation and employer: ________________________________________________________

Why are you interested in joining our organization?

What personal skill or strength of yours do you think would benefit our organization?

Do you have a committee you’d like to serve on or a particular area of interest?

What other volunteer commitments do you currently have?

Have you served on other nonprofit organization boards? If so, please list: them and any offices you held:

The (CASA program) board meets (once a month) on (the second Tuesday at 5 pm). Do you see any scheduling problem that might affect your attendance?


For Board Use Only

__ Nominee was referred by _________________________________.

__ Nominee was mailed an application packet. Date ________

__ Nominee had a personal meeting with chief executive, board chair, or other board member. Date ______

__ Nominee’s application was reviewed by the nominating committee. Date ______

__ Nominee was interviewed by the board. Date ______


Action taken by the board ___________________________________________________

The US Department of Justice has supported CASA advocacy since 1985 through its Office of Juvenile Justice and Delinquency Prevention.
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