Become a Big! BBBS Mentoring Program Application

Company

In the Big Brothers Big Sisters Twin Cities (BBBSTC) Beyond School Walls programs we focus on building supportive, safe, and caring relationships between our adult mentors and youth mentees. Mentors and mentees are paired 1:1 and meet on scheduled Wednesdays fifteen times throughout the school year. This is about once every two weeks.

Mentees are bused to the company for meetings. Meetings are facilitated by a BBBSTC staff member. BBBSTC staff will provide engaging lesson plans, icebreakers, activities, materials, and reflection questions. We ask all of our participants for a one year commitment once they’re matched . Consistently meeting with a mentee is important to build trust and grow a relationship. As a volunteer, your role is to be an adult friend, and someone who encourages, empowers, and elevates the voices of our youth.

Employer / School Information

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Many area employers are corporate partners with BBBS and wish to recognize and support the volunteer contributions made by their staff. This corporate support is an essential part of BBBS agency funding. I hereby give permission for BBBS to share with my employer that I am volunteering as a Big Brother/Big Sister. This consent will apply to my current or future employers, unless I notify BBBS in writing. This consent will expire upon my giving written notification to BBBS.

Contact Information

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Date of Birth

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Personal Information

Additional Languages Spoken:

Please provide insight into the other language(s) you speak:

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Military Service

Have you ever applied before to be (or have you been) a Big Brother or Big Sister?

If yes, where and when?

Do you have a car you could drive to and from match visits?

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Make a Referral!

Do you know anyone who might be interested in volunteering in our programs? If you would like to refer them to us, please provide name(s) and contact information:

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Big Brothers Big Sisters Media Release

I hereby give my permission for BBBSTC to use identifying information (full name, photograph,match profile information) about me now, and in the future, for agency publications, media productions, promotional materials, and online social networking media (Facebook, Twitter, blogs, etc). This publication consent will expire upon my giving written notification to BBBS. This revocation will not apply to existing publications or productions in stock for distribution. Last names of minors (Littles or High-School Bigs) will not be used in any BBBS publication without further written or verbal consent by the minor’s parent or legal guardian. (Please note BBBS encourages other media entities to abide by this policy, but ultimately, BBBS is not responsible for external publicity.)

Consent & Permissions

Big Brothers Big Sisters Twin Cities (BBBSTC) respects the confidentiality of program participant and volunteer records and, with the exception of situations listed below, shares information about program participants and volunteers only with BBBSTC staff members, certified volunteers, and interns. Identifying information will be released to other individuals or non-BBBSTC organizations only with the parent’s/guardian’s or volunteer’s written consent. All records are considered the property of the agency and not the agency workers or program participants or volunteers themselves. Confidentiality exceptions include the following:

1. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may

have access to child and volunteer records.

2. Members of the Board of Directors or external evaluators have access to child and volunteer files upon authorization of the Board of Directors.

3. Written information shall only be provided to law enforcement officials or the courts in response to a valid and enforceable subpoena.

4. Information shall be provided to an agency’s legal counsel in the event of litigation or potential litigation involving the agency.

5. State law mandates that suspected child abuse be reported to the appropriate authorities (local police or child protection agency).

6. If an agency worker/representative receives information indicating that a child or volunteer may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party. This may include a medical referral or report to the local law enforcement authorities.

7. At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties. Match parties are expected to respect and keep confidential such shared information. The information about the volunteer may include such items as: age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc. Information about the child may include such items as age, sex, race,religion, interests, hobbies, family situation, etc.

By checking the box below, you are confirming that:

You understand that any references listed may be contacted by mail, telephone or e-mail
You are in no way obligated to perform any volunteer service
The information provided may be used to conduct a background check, to include driving record check, criminal background check and other records where required by local, state or federal law for volunteers working with youth
BBBSTC is not obligated to match me with a young person; and as part of the enrollment process, BBBSTC will ask me to provide additional personal information prior to making any recommendations for acceptance

I have read the terms above and agree

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Contact Information