CASA Monthly Report Submission

CASA Monthly Update Form

*If you have more than one (1) case, please submit one (1) report for each case.

National CASA requires CASA Volunteers to keep monthly activity logs. In addition, the CASA Program can apply for grants and other funding based on the hours spent and miles driven by CASA Volunteers. Please complete your hours and mileage for each month.

CASA Information:

First Name *

Last Name *

Email *

Phone

Case Information:

Case Name *

Number of Children *

Reporting Month/Year (e.g. January 2023) *

Hours volunteered this month. This includes all training, case related activities, time spent documenting, time spent driving, time on the phone with CASA staff or parties to the case, time spent at court- any activity related to volunteering for CASA counts!

Hours *

Educational Advocacy Hours

Miles driven this month for CASA activities.

Miles *

Did you have face to face contact with the child(ren) on your case for this reporting period? *

Yes

No (please provide reason below)

Reason

What other types of contact did you make? (select all that apply) *

Attended Court

Phone (e.g., Voice Call, Facetime)

Email

Text Message

Visited School

How many out of court contacts* did you make with the child(ren)/youth?

Out of court contacts with the child/youth include face-to-face visits, phone calls, text messages, virtual calls, and/or emails. If the child(ren) is an infant, how many out of court contacts did you have with the caregiver and/or face-to-face visits with the infant?

Out of Court Contact(s) *

Services Provided This Month (select all that apply) *

Advocacy – This should be selected every month. (e.g., attendance at school meetings, court hearings, CCDCFS meetings, collaborating with other professionals)

Documenting (e.g., completing monthly updates and/or court reports)

Investigating (e.g., gathering information on family history, environment, relationships, records review)

Referral (e.g., other services, supports, and community resources)

Monitoring (e.g., compliance of court orders and case plan compliance)

Education Advocacy (e.g., requested records, read IEP, spoke with teacher or other school personnel, observed child at school)

Did the child’s placement change in the reporting month? *

Yes (Please complete the fields below)

No

Child's Current Zip Code:

Placement Type:

Full Address of Where Child Resides Now:

Continuing Education

Summary of In-service Training

List the title and date of each in-service training (e.g., Cultural Diversity, 01-01-23). If you attended an in-service training through CFACC, only submit title and date.

Date:

Training Name:

Type of Activity:

Training Hours:

Date:

Training Name:

Type of Activity:

Training Hours:

Date:

Training Name:

Type of Activity:

Training Hours:

Please submit any questions, comments or concerns.

Signature (type your full name) *

Today's Date (mm/dd/yyyy)

Select your assigned CASA Volunteer Coordinator to submit this report to: *

Rose Eyerman(reyerman@cfadvocates.org)

Cassidy Feiler (cfeiler@cfadvocates.org)

Nikita Stange (nstange@cfadvocates.org)

Please review your entries before submitting your CASA Monthly Update.

Mission: To make a difference for every child served through advocacy, education, and collaborative alliances.

Vision: Every child is seen, heard, and engaged, leading to permanency and hope.