CASA Las Vegas

Applicants Name (required)

Date of Birth (required)

Phone Number (required)

Alternate Phone Number

Your Email (required)

Street Address (required)

City (required)

State (required)

Zip (required)

DFS Caseworker's Name (required)

DFS Caseworker's Email Address

CASA's Name (required)

CASA's Phone Number

CASA's Cell Number

CASA's Email Address

Date of High School Completion (required)

Did You Receive a GED or High School Diploma? (required)

Name of College, University, or Training Program (required) (fax any supporting documentation to 222-3353)

Semester Scholarship Will be Applied To (required)

Name of School To Make Check Payable To (required)

School Street Address (required)

School City (required)

School State (required)

School Zip (required)