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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 about filling out the form, please contact your advocate supervisor or call the office at 985-876-0250.

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/Province *
Postal Code *
Additional Notes that May be Helpful:

Organization Memberships

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