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Request a Traveling Tutor

Complete the information below to request a Traveling Tutor for your CASA child (one form per child).  Please note that all items must be filled out before you can submit the form.  You will receive a confirmation email that your form has been received and we will contact you soon.  If you have any questions on filling out the form, please contact the office at 985-876-0250 or Donna Brunet dbrunet@casaofterrebonne.org.

CASA Volunteer's Name:
First Name
Last Name
Date of Request
CASA Volunteer's Phone Number:
CASA Child's Legal Name:
CASA Child's Age and Grade:
Name of School and School District
Primary Teacher's Name:
Teacher's E-Mail:
Tutor Gender Preference
Subject(s) to be Tutored:
Days of the Week Child is Available:
Does the Child have an IEP?
Does the Child have an IEP?
Does the Child have a 504 Plan?
Does the Child have a 504 Plan?
Does the Child have a Language Barrier?
Does the Child have a Language Barrier?
Placement's Name:
First Name
Last Name
Placement's Phone Number:
Placement's Address:
Country
Address Line 1
City
State
Postal Code
Additional Notes that May be Helpful:

Organization Memberships

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