Request a CASA - CASA of Lane County

If you would like to request a CASA volunteer for a child in need, please fill out the form below and we will contact you shortly. Or you can call Brenda Nepute, CASA Intake Coordinator, at (541) 868-3095.

Date
MM slash DD slash YYYY
Name of Person Requesting*
First Last
Email*
Phone*
Your Relationship to Child(ren)*
Child's Name, Age & Court # (if known)*
Child #2's Name, Age & Court # (if known)
Child #3's Name, Age & Court # (if known)
Reason Asking for a CASA Volunteer*
Provide the following information if known:
Location of the Children-Name & Address and Phone Number if known
DHS Caseworker
Child's Attorney
Mother's Name
Mother's Attorney
Father's Name
Father's Attorney
Are you concerned about the safety of these children?
Are these children homeschooled?
Any other information you think is important:

Provide the following information if known: