Mentor Application

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Before you Begin

This application will take approximately 20 minutes to complete. Please have the following ready before you begin:

  1. A saved image to upload of your driver's license or other official identification.
  2. A saved image to upload of your driving insurance if you are applying for the Community-Based program.
  3. Contact information for three references and any youth serving organizations you have been involved with in the last five years. References need to include one of each below:
    • Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other.
    • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student.
    • A friend or neighbor you have known for at least two years.
Programs
Community Based Mentoring

This is our traditional 1-1 match, where adult mentors are paired with youth ages 6-16 with the commitment to see each other at least 4 hours per month. Each match is hand-selected by our team based on shared interests, geography and personality. Matches plan their own outings filled with things they like to do, like sports, going to the beach or making music.



Lunch Buddies 

Lunch Buddies is a brand-new program that will take place during the 2024-2025 school year at Stanley Elementary School in Tacoma. Mentors (called "Bigs" in BBBS language) will go to their mentee's (called "Littles") school and eat lunch with them during the school's lunch hour. While having lunch together, matches will get to know each other and Bigs will support their Little in talking about the things they are interested in. This program is great if you have lunch times (around 10am-1pm) free during the week and are comfortable working with a child aged 6-8 years old. 



MentorU

Bigs in our MentorU program are paired with a high school student (grades 9 – 12th) to help them create a post-graduation plan. Through fun, interactive, and educational activities, Bigs will guide their Little in shaping their future while building a meaningful connection. Currently available at Interlake High School, in Bellevue, and West Seattle High School, all sessions are facilitated by Big Brothers Big Sisters staff and take place on school campus.


Mentor Information

Hidden Fields






based on program






i.e. Jr, Sr, II



xxx-xxx-xxxx

xxx-xxx-xxxx







^ Please click this button to select your Zip Code from the list.





Demographic information is collected to honor parent preferences and allows us to make matches based on shared life experiences. We are an inclusive organization and celebrate diversity!

enter as mm/dd/yyyy









Emergency Contact Information


xxx-xxx-xxxx


Pre-Interview Questions

Due to the nature of our program, Big Brothers Big Sisters of Puget Sound must take great care in the screening of prospective volunteers. Parents of youth in our program often ask questions about volunteers with whom their child will be matched. It will help us make a better match for you and assure we can support you during your involvement with our programs. The following information is provided so that you may make an initial determination as to your eligibility. The right to refuse the application of any person rests solely with the agency and is determined by the professional staff that it employs. The refusal of a particular application may include areas which are not listed below.  Big Brothers Big Sisters of Puget Sound does not discriminate on the basis of race, sexual orientation, gender identity or religion.











Mentor Application - Policies

Media Release

Sharing stories and celebrating your success is an important part of our mission!


I hereby authorize Big Brothers Big Sisters of Puget Sound to use my image, voice and/or performance for publicity purposes to promote the Big Brothers Big Sisters program.  I agree that there will be no compensation whatsoever for this participation or for the use of resulting materials by Big Brothers Big Sisters.  I further agree that this participation confers no ownership rights.  I understand that no personal history information will be revealed by the agency. From time to time stories may shared through our national organization.


Confidentiality & Reporting Neglect or Abuse
As a volunteer Big Brother or Big Sister, I understand that personal information about the Little I am matched with, and/or his/her family, should be held in confidence.  I understand that this confidentiality policy does not include my Program Coordinator or other Big Brothers Big Sisters agency staff who I might speak with regarding any circumstances of my match. Information that I share with people I know will be limited to information about the types of activities that my Little and I do together and will not reveal personal information that my Little shares with me.  When speaking to people I know about my Little, I will only use his/her first name and will not identify where my Little lives.

 

Reporting Abuse and Neglect: I will contact my Program Coordinator immediately if my Little shares any information regarding abuse or neglect or if I suspect any abuse or neglect.

 

I have read the above statement and understand Big Brothers Big Sisters of Puget Sound’s policy regarding confidentiality of my Little’s personal life.  I agree that I will fully adhere to the terms of the policy as a condition of my involvement with the agency, and understand that failure to comply with this policy may result in a severance of my relationship with the agency.  This statement shall remain in full force and effect for the entire duration of my involvement with Big Brothers Big Sisters of Puget Sound and thereafter.


Firearm Agreement


I will inform agency staff if I or someone I live with acquires a firearm (or an additional firearm) throughout any point of my involvement with the agency, and I agree to abide by the firearm storage agreement. 

 

As a volunteer Big Brother/Big Sister, I agree to keep all firearms/weapons that may be in my home inaccessible to my Little.  I will do this by assuring that the following precautions are taken:

  • All firearms/weapons in my household will be unloaded, locked-up, and inaccessible to my Little.

  • All firearms in my household are registered when legally required.

  • Any bullets or ammunition in my household will be locked-up separately from the firearms/weapons and will be inaccessible to my Little.

  • My Little will have no knowledge of firearms/weapons being stored in my home.

  • I will not carry a weapon on me during any match activity with my Little.

  • If I am a site-based Big Brother/Big Sister, I will not bring a weapon with me when I visit my Little at the site.

  • BBBSPS will consider waiving this for certain occupations (eg: police officer).

I realize that if there is a firearm/weapon in my household, even if I am not the owner, I am responsible for taking these safety measures throughout the duration of my match.  I understand that this agreement may be discussed with the Little’s parent or guardian in the match proposal call, and will be monitored by my Program Coordinator in follow-up calls.


Activities in the Volunteer's Home

Visits to the volunteer’s home are strictly prohibited in the first 3 months of a Community-based match.  Parent/Guardians are not permitted to allow home visits within the first 3 months of the match.  After 3 months, volunteers must have the consent of the Parent/Guardian in order for home visits to occur on outings and should consult with their Program Coordinator prior.  Any violation of this policy could result in immediate closure of the match.

 

Site-based program – activities outside the designated location (school or workplace) are prohibited including visits to the mentor’s home.


Overnight Activities

Overnight visits between Bigs and Littles are strictly prohibited except in the event that it is an agency sponsored event. Littles are never allowed to sleep or nap in the same bed for any reason with the Volunteer, another adult or another child. Parent/Guardians are not permitted to allow overnight visits between the child and volunteer outside of agency sponsored events. For agency sponsored overnights, the Little, Big, Parent, and Program Coordinator must each approve participation. Any violation of this policy may result in immediate closure of the match.


Updated Background Checks
I agree to inform Big Brothers Big Sisters staff of any involvement that I have with law enforcement for the duration of the time that I am matched in the program (this includes speeding violations for Community Based matches).  I understand that Big Brothers Big Sisters will run a background check on me every 3 years (minimum) that I am matched in the program.  Every 3 years I will respond to staff’s requests for background check authorization signatures and understand that failure to do so will result in my match being closed.  Staff will use professional judgment on whether any accusations or charges warrant closure of the match.

Transportation Policy

COMMUNITY BASED


Insurance Coverage

Volunteers should maintain minimum limits of auto liability coverage. It is very important – for your liability and for the agency’s – that you have the minimum coverage. In the event that minimum coverage is not met volunteers should discuss this with agency staff and a decision will be made regarding ability to participate in the community-based program where driving might occur.  

1.   I affirm that I have and will maintain Personal Auto Liability Insurance with the limits of at least $25,000/$50,000 Bodily Injury and $25,000 Property Damage (or $100,000 Combined Single Limit).

2.   I will supply a copy of my up to date auto insurance card when requested by Big Brothers Big Sisters of Puget Sound.


Accident Policy

In the event that a Little Brother/Little Sister is involved in some type of accident involving an injury during a match activity, Big Brothers Big Sisters of Puget Sound has an excess accident policy, which may provide certain benefits.  Benefits payable are determined by the following information.

                                                            

1.  If the injured is currently covered through a separate health insurance policy, that policy will act as primary insurance.  The excess accident policy provided by Big Brothers Big Sisters will act as a secondary insurance.  This means that the injured will have to submit the claim to his/her own insurance company prior to submitting a claim to Big Brothers Big Sisters accident insurance.

2.  If the injured party is not currently covered by any other health insurance policy, the excess accident policy provided by Big Brothers Big Sisters will act as primary insurance.  A claim may be submitted directly to the accident insurance company and will be subject to a $25 deductible.

 

The maximum medical expense amount $25,000 with a $25 deductible for primary medical claims, and a $250 per tooth deductible up to a maximum benefit of $500 for injuries requiring dental work.



SITE BASED


If I am a site-based Big Brother/Big Sister, I understand that I am not allowed to transport my Little at any time.


Mentor Training
I acknowledge that I will attend a Big Brothers Big Sisters group training prior to being matched.

Background Checks

DISCLOSURE FOR BACKGROUND CHECK


Big Brothers Big Sisters of Puget Sound “BBBSPS”) will procure a consumer report and/or investigative consumer report (as defined under the Fair Credit Reporting Act) on you in connection with your application for employment, or engagement as a volunteer or independent contractor. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the BBBSPS, throughout your employment, engagement or contract period.


TalentWise Solutions LLC (“TalentWise”), a consumer reporting agency, will obtain the report for the BBBSPS. Further information regarding TalentWise, including its privacy policy, may be found online at www.TalentWise.com. TalentWise is located at 19800 North Creek Parkway, Suite 200, Bothell, WA 98011, and can be reached at (866) 338-6739.


The background report may contain information bearing on your character, general reputation, personal characteristics, and/or mode of living. The information that may be included in your report include: social security number trace, criminal conviction records, public court or other government agency records, driving records (where driving is a required part of the job or engagement), educational records checks, verification of employment positions held, personal and professional references checks, and licensing and certification checks. The information contained in the report will be obtained from private and/or public record sources, including sources identified by you in your job application or through interviews or correspondence with your past or present coworkers, neighbors, friends, associates, current or former employers, educational institutions or other acquaintances.  You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report obtained by BBBSPS.

 

AUTHORIZATION


I have carefully read and understand this disclosure and authorization form and I have received a copy of the “Summary of Your Rights Under the Fair Credit Reporting Act” provided with this form. I have had the opportunity to review my rights. By my signature below, I consent to the preparation of background reports by TalentWise, and to the release of such reports to the BBBSPS and its designated representatives for the purpose of assisting the BBBSPS in making a determination as to my eligibility for employment, promotion, retention, engagement as a volunteer or independent contractor, or for other lawful purposes.

 

I understand that, to the extent allowed by law, information contained in my job or volunteer application, or otherwise disclosed to the BBBSPS by me before or during my employment, while volunteering or contracting, if any, may be utilized for the purpose of obtaining such consumer reports and/or investigative consumer reports about me. I understand that nothing herein shall be construed as an offer of employment, service as a volunteer or offer to engage an independent contractor.

 

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal/state/local), motor vehicle record agencies, my past or present employers, the military, and other individuals or sources to furnish any and all information on me that is requested by the consumer reporting agency.


By my signature (including electronic) below, I certify the information provided on and in connection with this form is true, accurate, and complete. I agree that this form in original, faxed, photocopied or electronic form will be valid for any background reports that may be requested by or on behalf of the BBBSPS.


This information is being collected to conduct the background screen on you. It will not be used for any other purpose.





If none input "N/A"



Photo Idenitification







Alternative ID


Mentor Consent

Recognizing that the primary purpose of Big Brothers Big Sisters of Puget Sound is to serve youth, I understand that:

  • Big Brothers Big Sisters of Puget Sound is not obligated to assign me to a match.

  • I am not obligated to accept a match when it is proposed by the agency staff; however, once a match is accepted, I understand that I have made a one-year commitment to the youth I have accepted and to Big Brothers Big Sisters of Puget Sound.

  • The information I provided may be used to conduct a background check, to include driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth.

  • I must inform agency staff of any involvement that I have with Law Enforcement during the duration of my match.

  • As part of our enrollment processes, we will be asking you to provide additional personal information prior to making any recommendations for assignment.

  • The preferences of a youth’s parent or guardian are respected in selecting a mentor. 


BBBS uses technology tools to enhance personal relationships. Our online platform allows volunteers, youth, parents and BBBS to connect securely using a web application. I understand that I will be enrolled in BBBS' online communication platform as an option of communicating with my mentee, their parent/guardian and BBBS staff. *Applies to Community Based Matches only; Site Based matches are not permitted to communicate outside of site-based sessions.

 

I acknowledge and agree that, for the duration of my involvement with Big Brothers Big Sisters of Puget Sound, any information I share with a staff member, including personal, health, or other information may be shared at the discretion of the agency staff with potential Little Brothers/Little Sisters and parent/guardian, and with the Little Brother/ Little Sister eventually selected for me and the parent/guardian, unless I specifically request otherwise. However, the names of the parties described shall be held confidential until the match is accepted by both parties.

 

I agree to adhere to the terms of Big Brothers Big Sisters of Puget Sound’s policies and practices as presented to me by agency staff, and understand that failure to comply with agency’s policies and practices may result in a severance of my relationship with the agency.

 

I understand that Big Brothers Big Sisters of Puget Sound is not liable to give reason(s) of non-acceptance.

 

I understand that records are not available for review by clients, parents/guardians, and/or volunteers.

 

I agree to program participation under the conditions above.



Type Name

Mentor References

Please provide at least three references below including:
  • Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other.
  • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
  • A friend or neighbor you have known for at least two years
Significant Other Reference - if no Significant Other please list another Friend/Family Member






# years
Employer/Coworker Reference






# years
Personal Reference







# years

Volunteer Youth Serving Organization Reference (please use button at bottom to add additional organizations if applicable)









(type na@na.org if not applicable)

# years