Request a CASA

If you would like to request a CASA volunteer for a child in care, please fill out this form and we will contact you shortly. All information submitted through this form is strictly confidential. If you have questions, contact the Intake Coordinator at waitlist@casa-lane.org.

Please note: We can only appoint a CASA if there is an open case with the Oregon Department of Human Services. If there is no current ODHS involvement with the child, we are unable to process the request. If you’re looking for support but do not have an open case with ODHS, click here for other available resources.

Your First and Last Name

Email Address

Phone

(###)

###

####

Your Relationship To Child(ren)

Child Information

• Child's Name & Age • Child #2's Name & Age • Child #3's Name & Age

Resource (Foster) Parent First and Last Name(s) (if known)

ODHS Caseworker First and Last Name (if known)

Court Case Number (if known)

Biological Mother’s First and Last Name (if known)

Biological Father’s First and Last Name (if known)

Safety Concerns

Please describe in detail the safety concerns you have for the child, as well as anything else that you think is important or relevant.

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