San Francisco — Request for Court Appointed Special Advocate (CASA) and/or Educational Rights Holder Referral Form

Source: https://sf.courts.ca.gov/system/files/general/pdf-fillable-casa-request-casa-and-or-educational-rights-holder-referral-update-1_1_2026-edits_0.pdf

Rev. 02/2026 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Sate Bar Number, and Address) FOR COURT USE ONLY

TELEPHONE NO: EMAIL ADDRESS: Superior Court of California, County of San Francisco Juvenile Justice Center 375 Woodside Avenue, Room 101, San Francisco, CA 94127 Civic Center Courthouse 400 McAllister Street, Room 402, San Francisco, CA 94102 CASE NAME: PIN (if applicable): PETITION NUMBER: REQUEST FOR COURT APPOINTED SPECIAL ADVOCATE (CASA) AND/OR EDUCATIONAL RIGHTS HOLDER REFERRAL

1. Name of Youth: Date of Birth:
2. Gender Identity/Pronouns: _____________Race/Ethnicity: ____________________
3. Current Placement City: ____________________________________ ☐ Confidential Placement
4. Primary language(s):_______________________
5. Current HSA-FCS PSW and/or JPD PO/SW:
6. Court Proceedings Stage/Current Case Plan: Prior CASA Assignment: ☐ Yes ☐ No
7. Reason(s) for Referral (please check all applicable): ☐ Educational Advocacy Needs ☐ Re-entry to Foster Care ☐ Sibling(s) in Foster Care ☐ Health Advocacy Needs ☐ Mental/Behavioral Health Advocacy Needs ☐ History of Sexual Abuse ☐ Family Treatment Court ☐ AB12/Transitional Planning Needs ☐ CSEC Concerns ☐ Absence of Community Connections ☐ Developmental Disability Advocacy Needs ☐ Juvenile Justice Involvement ☐ Other (please explain):
8. Describe the Youth’s Personality, Interests, Strengths and Needs (Please update SFCASA with new information such as placement and case plan changes to support best fit and timely matching by emailing ProgramAssistant@sfcasa.org.)

I am requesting a: ☐ CASA ☐ Educational Rights Holder Date: Parties noticed: ☐ Attorney for Dependent/Ward ☐ HSA-FCS ☐ JPD ☐ Attorney(s) for Parent(s) ☐ City and/or District Attorney ☐ For youth age 10 and older I have spoken with the youth about a CASA’s role and they want to be matched with a CASA.

Name of Referent and Relationship to Youth (Print) Signature of Referent

The Court hereby orders the approval of this Request for CASA and/or Educational Rights Holder through SFCASA. Approval of this request does not guarantee assignment of either.

Date ____________________________________________________ Judge, Unified Family Court, Superior Court of San Francisco

In order for a CASA volunteer to be appointed as the educational representative, a Judicial Council of California Form JV-535 limiting the educational rights of the parent(s) must be signed by the judicial officer and filed with the Court.

SFCASA PROGRAM GRIEVANCE POLICY

Every effort should be made to solve problems cooperatively and informally before presenting them as a formal grievance. We encourage anyone to contact the SFCASA office and ask to speak with the Program Director (or authorized to speak on their behalf) to discuss any concerns. Should informal efforts fail, the following policy is set forth in order to provide an outlet for complaints and a systematic means to resolve grievances.

If the grievance concerns a CASA volunteer or staff member please send a letter, along with supporting documents to:

SFCASA Executive Director, 1663 Mission Street, Suite 700, San Francisco, CA 94103

• Once received the matter shall be assigned to a staff member as appropriate. The Executive Director will have final say in the matter. • Documentation of any grievance filed against a volunteer shall be retained in the volunteer’s file.

If the grievance pertains to the Executive Director, please send a letter, along with supporting documents to:

SFCASA Board President, 1663 Mission Street, Suite 700, San Francisco, CA 94103

Once received the matter shall be reviewed by the Board President. The Board President shall have final say in the matter.

In order for a CASA volunteer to be appointed as the educational representative, a Judicial Council of California Form JV-535 limiting the educational rights of the parent(s) must be signed by the judicial officer and filed with the Court.