CASA REFERRAL

Thank you for referring a youth to the waitlist for a CASA advocate. Please fill out as much information below as possible. One of CASA's staff members will contact you if more information is needed.

Click here to view CASA's Grievance Procedure.

Email

Your Name

First Name

Last Name

Relationship to Child

Your Phone Number

(###)

###

####

Child's Full Name

Child's Date of Birth

MM

DD

YYYY

Case Number (DP/NP/DL/NL)

Social Worker

Courtroom Department Number

Minor's Attorney

Reason for Referral and/or Advocacy Needs