CITIZEN REVIEW BOARD MEMBER APPLICATION

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Dear Prospective Volunteer;

Thank you for your interest in the Citizen Review Board (CRB). Enclosed is an application, Board Member position description, and volunteer insurance form. Please fill out the application and insurance forms, and return them to our office to get your application process started.

The CRB is a program of the Oregon Judicial Department. We review the cases of children in the custody of the Department of Human Services (DHS), and of youth in the custody of the Oregon Youth Authority (OYA), who have been removed from their homes. The reviews are conducted by volunteer board members with staff support. We currently utilize over 375 volunteers throughout the state. We hope that you will become one of them.

To serve as a board member requires committing to one full weekday per month. Each board in your local county meets on a particular day of the month, such as the first Tuesday or the second Friday. The review day is typically an all day commitment. In addition to the review day itself, it takes an average of 6 to 8 hours of preparation time on your own to read case files. The information is sent to you approximately 10 days before the review day. Board members are also required to complete eight hours of training annually.

We seek people from all walks of life with varying levels of experience. Our mandate is to develop diverse boards with unique life experiences. Therefore, the primary qualifications are an interest in the welfare of children and families, the ability to maintain confidentiality, the ability to cope with sensitive and emotional cases, and the availability to follow through with attending reviews and required training. Our application process includes an interview, reference checks, a criminal history check, and a16-hour training.

If you have further questions, please feel free to call our Volunteer Resource Coordinator at (503) 731-3007 or toll free at (888) 503-8999. If you find yourself unable to volunteer at this time, please pass along this application packet to someone who may be interested. Thank you for your interest, and we look forward to hearing from you!

05/09/2021

* Required Field

First Name: *

Last Name: *

Middle Initial:

Street Address: *

City: *

State *

Zip: *

Email Address:

Home Phone Number:

Work Phone Number:

Cell Phone Number:

County

How did you hear about our organization?

Current Occupation & Employer:

Previous Employment:


The following questions are used to select a local board that is representativve of the community

	Date of Birth:	(mm/dd/yyyy)

	Gender:	Male Female
	Level of education (Select highest level completed)
	Some high school (no diploma/GED) GED or High School Diploma Some College College Degree Some post-graduate Work Graduate degree

	Ethnic Origin (Check all that apply)
	Caucasian Asian American African American/Black Latino/Hispanic Pacific Islander Native American/Native Alaskan Other

	Household Income Level
	Under $10,000 $10,000 - $14,999 $15,000 - $24,999 $25,000 - $34,999 $35,000 - $49,000 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 - $199,999 Over $200,000

	Are you or have you been a foster parent? No Presently am Formerly was
	Are you or have you been an adoptive parent? No Presently am Formerly was
	Please list any experience you have had which relates to foster care or child welfare (e.g., child advocacy, adoption, etc.)
	Are you able to attend reviews one set working day a month from 8:00 a.m. to 5:00 p.m.? Yes No
	Please indicate which days you are not available: Monday Tuesday Wednesday Thursday Friday
	What are your reasons for wanting to serve on the Citizen Review Board?
	In what other organizations are you involved?
	Please list three references (no more than one relative):

Name	Address	Phone




*Please read the following and add your initials here to acknowledge your consent: I understand that the Citizen Review Board will conduct a criminal history check. The existence of a criminal record may or may not disqualify an applicant from appointment. I understand that my application does not ensure appointment to a review board. I understand that the required orientation training will be part of the screening criteria in considering my appointment to a local board. I also understand that if appointed I will not be reimbursed for out-of-pocket expenses incurred while conducting my duties. Further, I understand that if appointed I will be called upon to attend all reviews of my assigned board. I understand that while there is variation from county to county, I could expect to meet monthly for four to eight hours. Finally, I agree to attend mandatory training as established by the Citizen Review Board.
*Please read the following and add your initials here to acknowledge your consent: I agree to keep confidential all information reviewed by the board, its actions and its recommendations, and to not use any information in the reviews to my advantage.

Word Validation:

Type the characters you see in the picture below. Letters are not case-sensitive.

	Applications will be forwarded to the judge or the judge’s designee in your county. Board members successfully completing the application process will be appointed by the Chief Justice of the State of Oregon

	05/09/2021	* Required Field
	First Name:	*
	Last Name:	*
	Middle Initial:
	Street Address:	*
	City:	*
	State	*
	Zip:	*
	Email Address:

	Home Phone Number:
	Work Phone Number:
	Cell Phone Number:
	County

	How did you hear about our organization?

	Current Occupation & Employer:

	Previous Employment: