BBBS Lone Starmentor2.0 Information and Consent Forms

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mentor2.0

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Personal Information






Volunteers must be 21 years old
Contact Information


Notice and Authorization for Background Check

Form 2970c
Disclosure and Consent to Release of Information Regarding Criminal or Abuse/Neglect History For Applicants, Employees or Volunteers of DFPS Contractors and Subcontractors









Form 2971c
Request for Criminal History and DFPS History Check for Purchased Client Services Contractors

Purpose: Use this form to submit background checks on contractors, and each employee, subcontractor, or volunteer who will be involved in direct delivery services with DFPS clients under a contract or who have access to personal DFPS client information.

Directions: An authorized representative for the contractor completes the contractor information and verification signatures. The representative then completes identifying information for each person required to have a background check. Attach additional copies of the form as needed if background checks are needed on more than three individuals. If additional space is needed for the required information, please attach a separate sheet containing the information.
BBBS Dallas Contractor Information


Identifying Information





















In addition to obtaining a DPS name-based criminal history check, fingerprint-based criminal history checks are required for any PCS contractor and individuals on their staff who, at the time of his or her initial background check request:
• currently lives or has lived outside of Texas within the past five years; or
• currently lives or has lived outside of Texas in the 24 months since his or her last fingerprint-based criminal history check was completed.
If the individual requires a fingerprint-based criminal history check, you must select one of the following choices and provide either an email address or phone number for the person. This information will be required when the person schedules a fingerprint appointment.



Required Documents


Match Agreement

BIG BROTHERS BIG SISTERS LONE STAR MATCH AGREEMENT & GROUND RULES

MENTOR2.0 PROGRAM 

mentor2.0 Team Agreement

 The role of the Partnership Specialist is to support the match pair, to monitor the match for safety and healthy relationship development, to provide support and curriculum delivery and to keep the match informed of mentor2.0 events and activities. In order to provide you with the best possible experience, we commit to:


  • Be available by phone and email to respond in a timely fashion to any of your needs or concerns.

  • Professionally monitor and assess your match for healthy development and will assist you if difficulties arise.

  • Support your progress and identify areas of growth.

  • Conduct satisfaction surveys and program outcome evaluations, to gain your ongoing feedback of our program.

  • Make sure you are aware of your school’s policies and requirements.

  • Monitor your weekly communications via the mentor2.0 (iMentor Interactive) platform.

  • Lead weekly curriculum based sessions at the Mentee’s school.

  • Lead an in person group session every 4 – 6 weeks.

  • Provide you with dates of in-person meetings for each academic year at the beginning of each academic year. 

mentor2.0 Mentor Agreement

As a volunteer Mentor, you are committing to:

  • Being matched with your Mentee for the duration of your mentoring relationship (either 3-years or 4-years).

  • Maintaining contact with your Mentee during school breaks (including the summer break) through approved communication options. (Note that this may require approval of some school districts.)

  • If the school district does not allow you to have contact with your Mentee over the summer, you will remain in contact with your Partnership Specialist to discuss future goals and plans for my match in the upcoming school year.

  • Contact your Partnership Specialist via phone or email if you are unable to attend a scheduled activity or complete an email exchange with your Mentee. Also, if outside phone contact is allowed, you will notify your Mentee in advance if you are unable to attend a scheduled activity or complete an email exchange. Mentors should promptly notify mentor2.0 staff and their Mentees if they will not be able to attend one of the scheduled events.

  • Not engage in any inappropriate communication with students. Inappropriate communication includes, but is not limited to: verbal abuse, swearing, and racist, sexist, homophobic, or otherwise prejudiced language. Such communication is expressly prohibited and will result in dismissal from the program.

  • Not have any unsupervised contact with your Mentee.

  • Limit interactions between you and your Mentee in the mentor2.0 program to the following instances:

    • mentor2.0 (iMentor) platform or BBBS platform
    • At in-person events supervised by mentor2.0
    • At the mentor2.0 office during designated office hours
    • At the student’s school during the mentor2.0 class session, lunch period or a mentor2.0 approved school function
    • At pre-approved, relationship building extra-curricular activities (must receive approval for each activity and approval at the discretion of your Partnership Specialist)
    • Utilizing Covid19 - Approved Communication
  • Adhere to all school district policies and to the individual school’s requests and requirements.

  • Be responsive to any concerns raised by Mentee’s parents/guardians over the course of their participation in the program.

  • Respond within 48 hours to any email messages sent by my Mentee, and if this is not possible, to notify my Mentee as well as mentor2.0 staff if I am unable to respond to or send email messages during any portion of the mentor2.0 program year.

  • Schedule a minimum of three (3) hours per month for email exchanges, and three (3) hours each four to six weeks for an in-person, face-to-face meeting with my Mentee at a scheduled group event, or at an approved make up activity.

  • Communicate regularly with my Partnership Specialist (a minimum of once every two (2) months) and will inform him/her of any of my concerns or issues with the match, and will respond to all phone calls, emails or letters from the agency staff. When requested, you will complete surveys and evaluations in a timely manner.

  • Notify my Partnership Specialist if my Mentee initiates any outside contact.

  • Contact my Partnership Specialist should a significant change in my life require me to end my match with my Mentee, and work with my Partnership Specialist to end the match with my Mentee in the most positive way.

  • Promptly inform my Partnership Specialist if my email address, home address, work address, employer, phone numbers, or employment status changes.

  • Discuss the parameters of gift-giving with the Partnership Specialist before making any gift to my Mentee.

mentor2.0 Mentee Agreement
As a Mentee, you are committing to:
  • Being matched with your Mentor for the duration of your mentoring relationship (either 3-years or 4-years).
  • Exchanging emails with your Mentor at least once every week through the approved mentor2.0 platform
  • Be an active participant in your weekly class sessions with your Partnership Specialist.
  • Attending your scheduled class time.
  • Attending activities scheduled by your school and mentor2.0.
  • Maintain contact with your Mentor during the school break, if approved by the school district via approved communication options
  • Not expect your Mentor to spend money on you or buy you things.
  • Not have any unsupervised contact with your Mentor.
  • Limit interactions between you and your Mentee in the mentor2.0 program to the following instances:
    • mentor2.0 (iMentor) platform or BBBS platform
    • At in-person events supervised by mentor2.0
    • At the mentor2.0 office during designated office hours
    • At the student’s school during the mentor2.0 class session, lunch period or a mentor2.0 approved school function
    • At pre-approved, relationship building extra-curricular activities (must receive approval for each activity and approval at the discretion of your Partnership Specialist)
    • Utilizing Covid19 - Approved Communication
  • Not engage in any inappropriate communication with your Mentor. Inappropriate communication includes, but is not limited to: verbal abuse, swearing, and racist, sexist, homophobic, or otherwise prejudiced language. Such communication is expressly prohibited and will result in dismissal from the program.
  • I will talk regularly with my Partnership Specialist to tell them about my match.
  • Notify my Partnership Specialist if your Mentor initiates any outside contact.
  • Promptly inform your Partnership Specialist if your email address, home address or phone number changes.
  • Not keep secrets about the match from your Parent/Guardian or your Partnership Specialist.
  • Tell your Parent/Guardian or Partnership Specialist if I am uncomfortable or have a funny feeling about anything that happens with my Mentor.

BIG BROTHERS BIG SISTERS LONE STAR GENERAL MATCH GROUND RULES
MENTOR2.0 PROGRAM


1. CHILD SAFETY
a. The Mentor will always respect the Mentee’s need for privacy and healthy personal boundaries.
b. The Mentor will refrain from any unapproved physical contact, such as wrestling, tickling, hitting, pinching and sitting on a Mentor’s lap. These behaviors are never allowed.
c. The Mentor will not accompany the Mentee to the bathroom for any reason.
d. The Mentor should not direct his or her Mentee to any website, book, or other material unless the Mentor has personally screened the material in question and is sure that it contains no objectionable or adult content. If a Mentor is unsure about whether material is appropriate for their Mentees, he or she should contact mentor2.0 staff.

2. CONTACT WITH YOUR PARTNERSHIP SPECIALIST
a. The match will be professionally monitored by mentor2.0 Staff throughout the life of the match. The Mentor and Mentee must stay in regular contact with the Partnership Specialist. This is essential for the development of the match and the safety of the Mentee.
b. Mentees will have regular weekly contact with the Partnership Specialist during the academic school year.
c. Mentors will have contact with their Partnership Specialist every week (through email), and will also communicate by phone (or in-person) at least once every two (2) months.

3. REPORT OF ABUSE
It is required by law to disclose the following to the appropriate authorities:
a. If any party of the match is a danger to himself/herself or someone else.
b. If any party of the match discloses physical, sexual, emotional abuse or neglect.

4. DISCIPLINE
a. The Mentor is a friend, not a Parent/Guardian. It is appropriate for the Mentor to correct misbehavior within the context of the match relationship. However, parenting is left to the Parent/Guardian.
b. Physical discipline of the Mentee by the Mentor is never allowed. Likewise, any demeaning, shaming, threatening, exploitative behavior is also never permissible.

5. VALUES
It is important that all match parties respect the different values and views each brings to the match relationship.

6. MEDICAL TREATMENT
a. The Mentor is prohibited from providing and/or administering any medication or medical treatment to the Mentee. If the Mentee is injured or needs medical attention, the Mentor should seek school personnel or mentor2.0 staff for help.

7. SUBSTANCE USAGE
The Mentor and Mentee are prohibited from using or being under the influence of alcohol or drugs while they are actively participating in mentor2.0 activities. The use of tobacco in the presence of the Mentee is also strictly prohibited.

8. LEGAL RESPONSIBILITY
The Mentor assumes no legal responsibility resulting from the relationship with the Mentee. If a family problem arises, financial or otherwise, the Mentee or Parent/Guardian may contact mentor2.0 staff for assistance.

9. OBEYING THE LAW
a. The Mentor is required to comply with all local, state and federal laws.
b. School districts require yearly criminal background checks on all volunteers serving in their schools. The Mentor will need to check with the Partnership Specialist at the beginning of each school year to determine what process will need to be conducted.
c. The Mentor is responsible for notifying their Partnership Specialist of any arrests, convictions and/or traffic violations that occur after the Mentor is matched.
d. In addition, the Mentor will notify their Partnership Specialist if anyone with whom they live is arrested or convicted for any criminal activity, including harm to a child.
e. The Mentee is responsible for notifying their Partnership Specialist of any arrests, convictions and/or traffic violations that occur after the Mentee is matched.

10. DISREGARD OF GROUND RULES
Any disregard of the above ground rules or any willful misrepresentation of information given to the agency by the Parent/Guardian, Mentee or Mentor will result in immediate review and possible closure from the program.
Big Brothers Big Sisters Lone Star Participant Confidentiality Agreement

Please read this document in its entirety.

 

As a potential participant of Big Brothers Big Sisters Lone Star (BBBSLS or BBBS), I understand that I have access to confidential information about volunteers and/or clients and families.   I fully understand and accept the responsibilities inherent in my role to maintain the complete confidentiality of all personal information, documents and parties who are engaged in this partnership (collectively, the “Confidential Information”), including myself, BBBSLS and all its affiliates and employees, public figures as well as all children and families that are served by this partnership. The obligation of confidentiality persists indefinitely and is not limited to the period of time beginning with my participation in BBBS and ending at the close of my participation.

 

In order for BBBSLS to provide responsible and professional services, it is necessary for volunteers, clients and parent/guardians of clients to disclose personal information.  BBBSLS respects the confidentiality of client/volunteer information.  Confidentiality applies to written records, electronic records, voice, verbal statements, pictures (motion or still) and the use of client/volunteer’s name in agency publications. All records are considered property of the agency, not of agency staff, partner agencies, clients, parent/guardians or volunteers.

 

I further agree to the following terms:

 

  • In the event that an actual breach of confidentiality or a release of Confidential Information has occurred or if a situation which I reasonably believe may result in a breach of confidentiality comes to my attention, I agree to immediately notify the designated BBBSLS representative and/or any other appropriate BBBSLS staff member. I understand and agree that I am required to report such breach or threatened breach of confidentiality regardless of whether the breach is caused by my own actions or by the actions of another person.

According to the Confidentiality Policy, information from client/volunteer records may only be shared with individuals/organizations as specified:

  • Identifying information regarding client/volunteer may be used in agency publications or promotional material only if the client/volunteer has given written permission.
  • Information shall be provided to law enforcement or courts only with a valid, enforceable subpoena.
  • Information shall be provided to BBBSLS legal counsel in the event of litigation or potential litigation involving the agency.
  • State law requires that suspected or disclosed child abuse, exploitation or neglect be reported to the Texas Department of Protective and Regulatory Services, Child Protective Services.
  • Information regarding match relationship and match closure reasons shall be provided to other BBBS agencies and youth serving organizations if requested.
  • If agency staff receives information that indicates that a client/volunteer may be dangerous to himself/herself or to others, steps shall be taken to protect the appropriate party, including a report to the law enforcement authorities.
  • When a child/volunteer is considered for a match, information is shared between the prospective parties. The identity of the parties is not revealed until after the parties agree to the match. Each party has the right to refuse the proposed match based on the anonymous information provided. Information shared may include: age, sex, race religion, education, interests, hobbies, marriage and family status, living situation, sexual orientation, reasons for applying to the program, expectations for match participation, a summary of the reasons an individual was chosen for the match, and all other information deemed relevant. The individuals to whom the information is provided agree not to share the information with any other person.
  • Certain outside bodies, including members of the Board of Directors, may have access to client volunteer records for the purposes of program evaluation, audit, accreditation, and/or for purposes of operating and making available approved software, on-line sites and login portals. All such authorized persons and representatives shall enter into a Confidentiality Agreement before receipt of any information from client/volunteer records.
  • Personally identifiable information of students which is obtained from education records provided by any school district or school will only be used or re-disclosed by BBBS or its authorized representatives in accordance with requirements of the Family Educational Rights and Privacy Act (FERPA). Such information may not be re-disclosed to any third party (except back to the school district or school) without prior written consent of the school district or school, the parent or eligible student. Such information may not be used for any purpose other than the purpose stated in the agreement with the school district or school pursuant to which the information was obtained, and will only be disclosed to those authorized representatives of BBBSLS who have a legitimate interest in the program pursuant to which the information is provided.

Other than in the instances set forth above, information from client/volunteer records shall not be released unless accompanied by an authorized consent to release information form signed by the client/volunteer. If the client is under the age of 18, the consent to release information form must be signed by the student’s parent or guardian.


Thank you for your careful consideration and willingness to uphold the privacy and confidentiality of those participating in Big Brothers Big Sisters.

Social Media/Digital Technology Policy

It is the policy of Big Brothers Big Sisters that all agency volunteers, youth, and Parent/Guardians who engage in the use of digital technology (texting, video chats) and/or social networking, which includes, but not limited to social media, blogs, wikis, Twitter, Facebook, etc., agree:   

  1. To remain a positive role model in all postings and/or communications.  
  2. To respect our youth, families, staff and volunteers' privacy and dignity. 
  3. To honor privacy and confidentiality by not sharing confidential information about a youth, family, volunteer, employee or BBBS, or use their image without consent even in a private forum. 
  4. To model healthy boundaries when communicating over social medial/digital technology.  Examples: To use prudent judgement in the time and manner in which you are contacting each other. 
  5. To be transparent in interactions.
  6. To be aware of surroundings especially when utilizing video technology. 
  7. To ensure privacy controls and settings restrict accessibility of youth in the program to only age-appropriate content when using any device while in the care of the volunteer. 
  8. To speak respectfully about BBBS and those affiliated with BBBS and refrain from posting information that reflects negatively on BBBS or any match participants. 
  9. To report any potentially inappropriate content immediately to BBBS.
  10. To abide by any other policy or procedure that BBBS may put into effect regarding social media, social networking and/or digital technology. 
  11. Most social media platforms have requirements that minors be age 12 before using the service.  Mentors should not connect with youth under the age of 13 on social media
  12. To adhere to all local, state and federal laws. 

Mentor Contract
I have read and agree to the mentor2.0 Match Agreement and Ground Rules
By signing this contract, you agree to abide by the Big Brothers Big Sisters mentor2.0 policies and standards set out in the Match Agreement and Ground Rules. Failure to act in accordance with these guidelines can result in being unmatched from your mentee and dismissed from the program. 

I have read and agree to the BBBS Volunteer Confidentiality Agreement and Social Media and Digital Networking Policy.

Program Requirements Agreement