Request for Referral

Friends of the Portsmouth Juvenile Court > Request for Referral

Get Started

CASA can only be assigned to a case involving child abuse or neglect. A judge has the sole authority to assign CASA. If you would like to request that a judge appoint a CASA, please complete and submit the form below.

Fill Out Request for Referral

In the Commonwealth of Virginia in and for the 3rd Judicial District of Virginia
Portsmouth Juvenile and Domestic Relations District Court
City and County of Portsmouth, Virginia
Portsmouth CASA Program
Fax: 757-393-2034 Email: PortsmouthCASA @fopjc.org
Type of Case*
- Foster Care
- Custody
Reason for Request*
Referred By*
- Parent/Guardian
- DSS Worker
- Guardian ad Litem
- Attorney
Name
First Last
Signature
Date
MM slash DD slash YYYY
Contact Number
Name of Child(ren)
Petition Number(s)
Custodial Parent (if custody)
Date Dependency Declared (if foster care)
*Court Use Only*
- Approved
- Not Approved
*Please include CASA Appointment Order Form DC-544 with approval
*CASA Program Use Only*
Date Received
CASA Assigned
Comments
This field is for validation purposes and should be left unchanged.