Guardian/Youth Inquiry Form

Welcome!

Thank you for your interest in Big Brothers Big Sisters. This is only an inquiry, not an application.

*****PLEASE NOTE: At this time, we don't have any male mentors. IF your male child is interested in being matched with a FEMALE mentor, please proceed with the inquiry process. Otherwise, please check back in 6 months.*****

**A valid email address is required for communication purposes**

We look forward to talking with you.

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

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?
Graduation Year This is the year the youth will graduate.

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 (A valid email is required for communication purposes)

Contact Preference

Family Information

Which county does your child live in?

County

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Referral Detail ID

Parental Permission

By clicking submit:

I understand that I will be contacted by Big Brothers Big Sisters regarding program enrollment.
I understand that after completing the enrollment process my child may have the opportunity to be matched with an adult mentor who has been screened by a Big Brothers Big Sisters Coordinator.

Contact Information