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NOTICE
This is to inform you Big Brothers Big Sisters (“BBBS”) may obtain information about you and/or your history related to potential criminal activity. The report from authorized sources may include, among other information, arrest, conviction, and driving record information. BBBS may additionally obtain information concerning your background, character, medical conditions, employment, education, and military experience. Information obtained by BBBS will be used only for the purposes of assessing your suitability to become a volunteer and matching you with a Little Brother or Little Sister.
AUTHORIZATION
I hereby authorize and instruct BBBS to procure a report on me, including a criminal background history, which I understand may include, among other information, arrest, conviction, and driving record information. I also authorize and instruct BBBS to verify my Social Security number and to investigate my background and character in any manner they see fit to evaluate my potential as a Big Brother or Big Sister, including obtaining information from medical providers, employers, educational institutions, military agencies, and any other sources. If I become a volunteer for BBBS, I authorize BBBS to repeat these investigations at any time for as long as I remain a volunteer. I authorize BBBS to disclose relevant information obtained from its investigations to the parent/legal guardian of any child considered as a possible Little Brother or Little Sister to effectively enable the parent to exercise “parental choice” in accepting or denying me as a Big Brother or Big Sister for their child. I authorize and instruct any individual, corporation, and public or private entity having knowledge about me to furnish to BBBS any and all information they may have regarding me. I unconditionally release and hold harmless BBBS and its officers, directors, employees, and agents and any party furnishing information to them pursuant to this authorization from any liability, claims, charges, costs, or causes of action which I or my heirs, executors, or assigns may have as a result of the delivery, disclosure, non-disclosure, or omission of any information. I additionally agree to indemnify BBBS and its officers, directors, employees, and agents for any and all attorney fees, court costs, and other expenses resulting from investigating my background, gathering information concerning me, or verifying personal information about upon the written request of law enforcement agencies. BBBS uses technology tools to enhance personal relationships. Our online platform allows volunteers, youth, parents and BBBS to connect securely using a web application. Furthermore, I understand that BBBS holds the right to deny my participation in the program and, for confidentiality, is not required to disclose reasons for doing so. All parties agree that elecronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility. A photocopy of this authorization may be accepted in lieu of the original.
• 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.
BIG BROTHERS BIG SISTERS LONE STAR MATCH AGREEMENT & GROUND RULES
MENTOR2.0 PROGRAM
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.
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:
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.
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.
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.
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.
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.
It is important that all match parties respect the different values and views each brings to the match relationship.
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.
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.
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.
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.
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.
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:
According to the Confidentiality Policy, information from client/volunteer records may only be shared with individuals/organizations as specified:
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.
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:
I hereby certify that the information provided in this application is true and complete to the best of my knowledge and subject to verification by the agency. I authorize the agency its affiliates and their representatives to investigate all information given and to secure additional information, if necessary. I understand that any misrepresentation or omission of a material fact on my application or during my interview process may be justification for refusal of volunteer placement, or if placed, will be grounds for dismissal without advance notice.
I understand that and consent to the following:
1) The references and youth organizations I listed may be contacted by mail, telephone, text or email;
2) I am in no way obligated to perform any volunteer services;
3) I will notify my references and any youth serving organization that they should comply with Big Brothers Big Sisters request to complete a reference;
4) The information I provided may be used to conduct a background check now and for as long as I am involved with the agency, to include driving records check, sex offender check, criminal background check, public domain check, and other records where required by local, state, or federal law for volunteers working with youth;
5) In order for Big Brothers Big Sisters Lone Star (BBBSLS) agency to provide responsible and professional services, it is necessary for me, the volunteer, to disclose personal information.
6) All records are considered property of the agency, not of agency staff, clients, parents/guardians, volunteers or authorized persons or representatives; Information from the application interview process, or match support process may be shared between BBBS and partnership agencies when applicable;
7) Big Brothers and Big Sisters Volunteers, as well as the children BBBS serves, their parents/guardians, and BBBS staff and Board Members, are not excluded on the basis of race, religion, national origin, color, gender, marital status, sexual orientation, gender identity, veteran status, or disability;
8) Parents are given the opportunity to express volunteer preferences in a match and those preferences are honored;
9) I must complete a training prior to being matched with a youth;
10) BBBS is not obligated to match me with a youth;
11) If I am accepted as a Mentor, I understand my obligation to meet with my Mentee regularly and to inform BBBS mentor2.0 staff as to the status of my match relationship every month. I further agree to accept the supervision of the BBBS mentor2.0 staff and will discontinue my service if I am requested to do so by the agency.;
12) I understand Big Brothers Big Sisters has a ZERO TOLERANCE FOR ABUSE and takes all allegations of abuse seriously. BBBS will cooperate fully with the authorities to investigate all cases of alleged abuse.
I have read the above statements and accept them as conditions of volunteering. All parties agree that electronic/digital signatures are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.
mentor2.0 Forms