Todays Date:
	Your First Name:
	Your Last Name:
	Your Email:
	Preferred Phone:
	Mailing Address:
	First Language:	English Spanish French Other
	If you checked other, please specify what language:
Reading Speaking Writing English FluentProficientBasic comprehension FluentProficientBasic comprehension FluentProficientBasic comprehension Spanish FluentProficientBasic comprehension FluentProficientBasic comprehension FluentProficientBasic comprehension French FluentProficientBasic comprehension FluentProficientBasic comprehension FluentProficientBasic comprehension Other FluentProficientBasic comprehension FluentProficientBasic comprehension FluentProficientBasic comprehension
	Are you a student?	Yes No
	If so, where and what grade or level.:
	Are you seeking to complete your school or court community service requirement?	Yes No
	If so, how many hours are you hoping to complete? By when?
	Do you have a license, certification, degree or training in a specific area for which you would like to volunteer?	Yes No
	If you checked yes, please tell us more:
	Please indicate which volunteer activities interest you:	Teaching English Teaching Spanish literacy Teaching Computers Teaching Other: Phone Banking Filing Answering phones Pro Bono Legal Work Help With Special Events Help With Job Placement Whatever You Need Me For Other:
	I have read the information about CASA's Departments
	The site(s) where I prefer to volunteer:	Silver Spring Workers' Center Pine Ridge Community Center Baltimore Wheaton Shady Grove Langley Park
Please select one of the following: I am able to volunteer on a regular basis. I am able to volunteer on a one-time or sporadic basis. Please indicate when you can start. If you can volunteer regularly, please indicate your weekly availability:   Sun Mon Tue Wed Thurs Fri Sat AM PM
	Is there anything else you would like to tell us about your interest in volunteering at CASA?

Thank you very much for your interest in volunteering with CASA of Maryland. You should hear back from us within two weeks. If not, you may try contacting us at: volunteer@casamd.org . Please use this email only in reference to application forms you have already submitted.

You may also print this form out - ENGLISH | SPANISH
Email it to: volunteer@casamd.org
Fax it to: 301-270-8659
Mail it to: Volunteer
Development Office
CASA of Maryland
310 Tulip Avenue
Takoma Park, MD 20912