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(A) Authorization to Release Information (Recommended) - Use of this Form: The CASA volunteer is responsible for gathering family information in his/her assigned case. The Family Court Order assigning the CASA volunteer provides the authority for obtaining information regarding the children involved in the case. However, it does not provide the ability to obtain information regarding the parents, other family members, or other caregivers, thus an Authorization To Release Information form is required. This form will be reviewed and signed by any individuals involved with the case, other than the children, granting permission for CASA to gain necessary information. Once the CASA volunteer has authorization from the individual, this form and Court Order are sent to the necessary service providers.
(B)(C)(D) NYS UCS HIPAA Release Form (OCA Official Form #960) (Required) - Use of this Form: Signature on this form is required to obtain (B) medical; (C) mental health; and (D) alcohol and other substance abuse records.
(E_1) Notice of Assignment (Recommended) - Use of this Form: This form is to be used to introduce the volunteers to the parties involved in each case and to service providers. You will customize this for each intended recipient, using only the names relevant to your information gathering. If you are using this form to notify the court of the CASA volunteer assignment, remember to add a ‘cc’ to all parties’ attorneys in the case or in the event of self-representation, the parties themselves.
(E_2) CASA Fact Sheet (Recommended) - Use of this Form: This form provides a brief overview of the CASA volunteer role to distribute to parties, families, service providers, and potential volunteers and to use as a handout for public presentations.
(F) CASA Volunteer Evaluation (completed by volunteer) (Sample) - Use of this Form: This form is distributed to the CASA volunteer to complete on an annual basis or upon completion of his/her service to the program.
(G) CASA Volunteer Evaluation (completed by supervisor) (Sample) - Use of this Form: The CASA volunteer supervisor uses this form to complete annual evaluations of each CASA volunteer. This form should be completed and reviewed in the volunteer’s presence.
(H) CASA Volunteer Recommitment Form (Sample) - Use of this Form: The letter of recommitment would be used for a CASA program to update its roster, on a case-specific basis. The form should be sent only to CASA volunteers whom the program would like to see continue as volunteers taking cases. These volunteers may not have had a case assigned recently or they may have taken a leave of absence. This form should not be sent to volunteers whom the program wants to counsel out of being a volunteer taking a case.
(I) Volunteer Application (Recommended) - Use of this Form: All CASA volunteer applicants are required to complete a written application, which will be utilized to determine the suitability of the applicant and begin the screening process.
(J) Volunteer Interview Questions (Sample) - Use of this Form: All CASA volunteer applicants are required to be personally interviewed by an appropriate CASA program staff member. This process is the most important element in the screening process for new volunteers and assists in determining the suitability of the applicant for volunteering with the CASA program.
(K) Reference Questionnaire (Sample) - Use of this Form: All CASA volunteer applicants must submit the names of three or more references on their application, at least two of whom are unrelated to the applicant. This form is to be used once the CASA volunteer applicant has been interviewed. References are another piece of the screening process and play an integral part in determining the suitability of the applicant.
(L) State Central Register Form (Required) - Use of this Form: All potential CASA volunteers, staff, and board members are required to submit this notarized form to the CASA program, so that the New York State CASA Association (CASANYS) can forward the information to the The Statewide Central Register of Child Abuse and Maltreatment (SCR) for a background check. This form is the authorization of release from the individual for the CASA program to receive the information obtained from the SCR. CASANYS notifies the CASA program of each individual’s clearance or indicated report. Any applicant found to have an indicated report involving child abuse or neglect or related acts that would pose risks to children or the CASA program’s credibility is not accepted as a CASA volunteer, staff, or board member.
(M) Volunteer Job Description (Recommended) - Use of this Form: This form is provided to all CASA volunteers documenting acknowledgement of responsibilities and agreement to comply.
(N) Volunteer Policy and Procedure Manual (Recommended) - Use of this Form: All CASA volunteers are provided a copy of this manual and must provide signed acknowledgement of reading and understanding the policies.
(O) CASA Volunteer Oath of Confidentiality (Sample) - Use of this Form: CASA volunteers who have been appropriately screened, have successfully completed training, and participated in court observation, must then take an Oath of Confidentiality. This form is used in Family Court for the judge to swear in each volunteer.
(P) Certificate of Completion (Sample) - Use of this Form: All CASA volunteers must complete the 30-hour National CASA Volunteer Training. This form is used to certify completion of the training.
(Q) Volunteer Release (Sample) - Use of this Form: This form may be used either when a CASA volunteer must be taken off a case or when the case assignment has come to an end.
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Web page updated: April 12, 2010 - www.NYCOURTS.gov