Become a Board Member

Board of Directors

If you are interested in serving on the CASA board, please feel free to contact any of the current board members or the administrative office at 865.425.0888.

Russ Nellis- President
Hannah Fatheree-Treasurer
Richelle Ballenger-Secretary
Britt Autry
Adrienne Landes
David Mandl
Ashley Meredith
Kay Overby
Jewel Shelton
Ram Uppuluri

Board Member Information

Click on the links below to review resources. If you would like to apply to be on the board, you can fill out an online application or download the PDF version to fill out.

Online Application

Board Application-Fillable 2024
Board Member Responsibilities
Board of Directors Pledge
Expectations of a Board Member
Mission, vision and Purpose Statement

Board Member Application

Please fill out the below information.

"*" indicates required fields

Personal Information

Full Name*

First Last

(Maiden)

Last

Prefer to be called

First

Birthdate*

Month

Day

Year

Sex*

Home Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone

(please include area code)

Cell Phone*

(please include area code)

Preferred Forms of Contact*

Home Phone

Cell Phone

Times Easily Reached

Other Languages Spoken*

Emergency Contact Info

Contact Name*

First Last

Relationship*

Contact Phone*

(please include area code)

Alternate Phone*

(please include area code)

Contact Address*

Street Address Address Line 2 City State / Province ZIP / Postal Code

Current Employment

Current Employer*

How Long Have You Been Employed There?*

Position / Title*

(full or part-time)

Work Phone*

(please include area code)

Responsibilities*

May we contact you at work?*

Yes

Does your employer have an employee volunteer time/donation matching plan?*

Yes

Phone*

(please include area code)

Board Candidate Information

Have you had personal experience involving any of the below?

(please check all that apply)

Child Abuse or Neglect

Department of Human Services

Department of Children's Services

Juvenile Court System

Foster Care

Adoption

Agencies offering services to a child

Please list any board service,volunteer work,special training,relevant skills, Professional / Civic / Social Affiliations, community activities, hobbies or special interests that may be useful to your board placement.*

How did you become aware of CASA?*

Briefly describe why you are interested in serving on the CASATNH board:*

Which of your skills would you like to utilize on theb board?

(please check all that apply)

Board Development

Strategic Planning

Fundraising

Financial Management

Community Networking

Marketing

Other:

Board Candidate Questionnaire

If selected, how do you feel you could contribute to the success of CASATNH?*

Are you willing to give time,energy and resources (within your means) to support the mission of CASATNH?*

Members stay connected to CASATNH through meeting attendance,committee work, events, and e-mail. Do you have the time and resources to be an active member of CASATNH?*

Is there a committee you would like to serve on or a particular area of interest?*

What are your expectations from the Executive Director?*

Anything else you would like us to know?*

References

Please provide 3 personal references. Email or mailing addresses (include PO box number and zip code) *References cannot be related to applicant.

Reference #1

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

Reference #2

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

Reference #3

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

As a part of the background investigation, we may conduct a criminal records check, a monitor vehicle division record check, education, employment history, credit history, and/or child protective services check. Please complete the authorization for this and certification.

Authority to Obtain Information

I authorize CASA of the Tennessee Heartland to obtain information concerning my suitability to become an employee of this agency from the Department of Children's Services; the Child Abuse Register; the Department of Corrections; the District Attorney's office; juvenile, civil and employment history; credit history, and any other screening agency.

Digital or Physical Signature*

10/17/2026

Information obtained under the above release shall be held in confidence and shall be used exclusively to determine the suitability to serve as an employee.

Certification of Suitability

I, the undersigned, hereby certify, that I have had no convictions resulting from a criminal offense (excluding traffic violations) nor is there any criminal action or investigation pending. I further certify that I have had no convictions or changes pertaining to child abuse or child neglect nor have I ever been investigated by any social services agency regarding allegations of child abuse or child neglect.

Digital or Physical Signature*

10/17/2026

If you are ineligible to certify the above please describe the circumstances below

Board Member Application

Please fill out the below information.

"*" indicates required fields

Personal Information

Full Name*

First Last

(Maiden)

Last

Prefer to be called

First

Birthdate*

Month

Day

Year

Sex*

Home Address*

Street Address Address Line 2 City State ZIP Code

Email*

Home Phone

(please include area code)

Cell Phone*

(please include area code)

Preferred Forms of Contact*

Home Phone

Cell Phone

Times Easily Reached

Other Languages Spoken*

Emergency Contact Info

Contact Name*

First Last

Relationship*

Contact Phone*

(please include area code)

Alternate Phone*

(please include area code)

Contact Address*

Street Address Address Line 2 City State / Province ZIP / Postal Code

Current Employment

Current Employer*

How Long Have You Been Employed There?*

Position / Title*

(full or part-time)

Work Phone*

(please include area code)

Responsibilities*

May we contact you at work?*

Yes

Does your employer have an employee volunteer time/donation matching plan?*

Yes

Phone*

(please include area code)

Board Candidate Information

Have you had personal experience involving any of the below?

(please check all that apply)

Child Abuse or Neglect

Department of Human Services

Department of Children's Services

Juvenile Court System

Foster Care

Adoption

Agencies offering services to a child

How did you become aware of CASA?*

Briefly describe why you are interested in serving on the CASATNH board:*

Which of your skills would you like to utilize on theb board?

(please check all that apply)

Board Development

Strategic Planning

Fundraising

Financial Management

Community Networking

Marketing

Other:

Board Candidate Questionnaire

If selected, how do you feel you could contribute to the success of CASATNH?*

Are you willing to give time,energy and resources (within your means) to support the mission of CASATNH?*

Members stay connected to CASATNH through meeting attendance,committee work, events, and e-mail. Do you have the time and resources to be an active member of CASATNH?*

Is there a committee you would like to serve on or a particular area of interest?*

What are your expectations from the Executive Director?*

Anything else you would like us to know?*

References

Please provide 3 personal references. Email or mailing addresses (include PO box number and zip code) *References cannot be related to applicant.

Reference #1

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

Reference #2

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

Reference #3

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Daytime Phone*

(please include area code)

Email*

Authority to Obtain Information

Digital or Physical Signature*

10/17/2026

Information obtained under the above release shall be held in confidence and shall be used exclusively to determine the suitability to serve as an employee.

Certification of Suitability

Digital or Physical Signature*

10/17/2026

If you are ineligible to certify the above please describe the circumstances below