By submitting this application, I hereby certify that all statements made on this application are true. I am aware that any omissions, falsifications, misstatements or misrepresentations above may disqualify me from consideration and, if I am appointed to the board, may be grounds for my removal at a later date.

I expressly authorize, without reservation, Alcovy CASA, Inc., its representatives, employees or agents to contact and obtain information from all references and to otherwise verify the accuracy of all information provided by me in this application. I hereby waive any and all rights and claims I may have against Alcovy CASA, Inc., its agents, employees or representatives, for seeking, gathering and using such information in the application process. I also hereby waive any and all rights and claims I may have against all other persons, corporations or organizations for furnishing such information about me.

The mission of Alcovy CASA, Inc. is to provide screened, trained and supervised volunteers to advocate for the best interests of abused and neglected children in the juvenile courts of the Alcovy Judicial Circuit. Alcovy CASA, Inc. Board Members are expected to support the mission of Alcovy CASA, Inc.

 I hereby certify there is nothing in my past or present which would negatively reflect on Alcovy CASA’s mission statement of advocating for the best interests of abused and neglected children.

By applying for appointment to the board, I hereby agree to support the mission of Alcovy CASA and will promote child abuse and neglect prevention in my personal and professional life.