Become a Board Member

Contact Information

First Name(*)

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Last Name(*)

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Email(*)

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Telephone (xxx-xxx-xxxx)(*)

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Address 1(*)

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Address 2

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City(*)

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State/Province(*)

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Zip/Postal Code(*)

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Current Occupation

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Short Answers

1. Please briefly describe your specific skills, academic and professional background, and other relevant experience that you hope to contribute to this board.(*)

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2. Why do you seek a position on this board?(*)

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3. Are you currently serving on another board of directors for another organization? If so, please list the organization’s name and your position/role.

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Screening Requirement Policy

I understand that if I am selected to move forward, I will need to pass a thorough background check in accordance with National CASA/GAL standards before being accepted to the board of directors and every four years thereafter, to include:

criminal records check from the court jurisdiction in which I currently reside and work
state criminal records check
national criminal records check
national sex offender registry check
child protective services check
social security number verification or the equivalent that allows for additional names, aliases and/or addresses to be obtained for further checks

I understand and accept the above Screening Requirement Policy.

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Please enter your full name in the textbox below to accept the Screening Requirement Policy(*)

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I understand that by typing my name and clicking on "Submit", I am electronically signing this document.

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Today's Date

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