Inclusion Statement

At Big Brothers Big Sisters of Southeast Michigan we believe in the dignity and worth of all individuals. We believe that every young person deserves unconditional support and acceptance, no matter their race, religion, gender or orientation. We encourage any and all interested young people and potential mentors to inquire and learn more about being in a supportive, developmental mentoring relationship.

Youth Information

First Name

Last Name

Application Name

Concatenated from First + Last

Preferred Name

Birthdate

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?
School

School Account ID

Race/Ethnicity

American Indian or Alaska NativeAsian IndianBlack or African AmericanChamorroChineseFilipinoHispanic - CubanHispanic-Mexican,MexicanAmerican,ChicanoHispanic-Other Latinx or Spanish originHispanic - Puerto RicanJapaneseKoreanMiddle Eastern or North AfricanNative HawaiianOtherOther AsianOther Pacific IslanderPrefer not to saySamoanSome other race or originVietnameseWhite or Caucasian

Guardian's Relationship to Youth

The parent/guardian is this child's

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County:

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

Contact Information