Youth Inquiry Form
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Non-Discrimination Policy
Big Brothers Big Sisters of Central Indiana follows a non-discrimination policy that prohibits exclusion of potential volunteer Bigs, youth, parents/guardians, board members, or agency staff on the basis of race, color, religion, age, pregnancy, gender, gender identity or expression, sexual orientation, national origin, ancestry, disability, veteran status, marital status, or any other protected class.
*
We currently only enroll children ages 8-14.
If you experience any technical difficulties while completing this form, please contact Drew Neddo at dneddo@bbbsci.org or call (317) 472-3717.
Youth Information
First Name
Last Name
Application Name
Concatenated from First + Last
Preferred Name
How old is your child? *Your child must be 8-14 years of age. If they are not within this age, they are not eligible.
Please select...
8
9
10
11
12
13
14
Birthdate (mm/dd/yyyy) *Child must be between the ages of 8-14.
Gender
Please select...
Male
Female
Trans Male
Trans Female
Genderqueer/Nonbinary
Different Identity
Prefer not to say
Personal Pronouns
Please select...
He, Him
She, Her
They, Them
Other pronouns
How does the youth identify?
What pronouns does the youth use?
School
Graduation Year from High School
Please select...
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
This is the year the youth will graduate.
x
School Account ID
Race/Ethnicity
American Indian or Alaska Native
Asian - Chinese
Asian - Filipino
Asian - Indian
Asian - Japanese
Asian - Korean
Asian - Other
Asian - Vietnamese
Black or African American
Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano
Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican
Middle Eastern or North African
Other
Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian
Pacific Islander - Other
Pacific Islander - Samoan
Prefer not to say
White or Caucasian
Referral Detail ID
Referral Detail Name
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Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Mobile Phone (000-000-0000)
Personal Email
I prefer to be contacted by
Please select...
Phone
Email
Text
Family Information
Is your child/family involved in any of these other organizations?
Edna Martin Christian Center
Catholic Charities
CAFE
Mid-north Promise Program
My family lives in a Glick Housing Property
My child is not involved in any of those programs.
Mailing Street Address
Mailing City
Mailing State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
County: we only serve Marion, Hamilton, and Johnson counties.
Please select...
Hamilton
Johnson
Marion
Do you live in the Windsor Park Apartments?
Yes
No
Guardian's Relationship to Youth
Your relationship to this child
Please select...
Mother
Father
Step-Mother
Step-Father
GrandMother
GrandFather
Aunt
Uncle
Relative: Other
Foster Parent
Teacher
Counselor
Clergy
Probation Officer
Non-Relative: Other
Self-Emancipated Minor
Social Worker-Case Mgr
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Contact Information