Youth Inquiry Form
Youth Information
First Name
Last Name
Application Name
Concatenated from First + Last
Preferred Name
Birthdate
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?
Graduation Year from High School
Please select...
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
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
Pacific Islander - Chamorro
Pacific Islander - Native Hawaiian
Pacific Islander - Other
Pacific Islander - Samoan
White or Caucasian
Other
Prefer not to say
Guardian's Relationship to Youth
The parent/guardian is this child's
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
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Mobile Phone
Personal Email
I prefer to be contacted by
Please select...
Phone
Email
Family Information
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:
Please select...
Caroline County
King George County
Spotsylvania County
Stafford County
Fredericksburg City
Other
How did you hear about Big Brothers Big Sisters?
BBBS Board/Staff
College Partner
Faith Organization
Former/Current Big
Fraternity/Sorority
Legal System
Local Website
Media - Newspaper
Media - Radio
National Website
Neighbor/Friend/Relative
School
Service Organization
Special Event
Therapist/Counselor
Other
If Other, please add details here
Referral Detail ID
Contact Information