Real Men Read Application

Contact Information

Full Legal First Name

Middle Initial

Full Legal Last Name

Street Address

City

State

Zip Code

Work Phone

Cell Phone

E-mail Address

Date of Birth

Social Security # (for background checks)

Do you have a driver's license?

Driver's License Number

Driver's License Expiry

Please upload a copy of your license

If you can't upload a driver's license, please email a copy or bring your license to the agency so an employee can help you scan it in!

Work Information

Current Employer

Occupation/Job Title

Person to Notify in Case of Emergency

Full Name

Relationship

Cell Phone

E-Mail Address

Book Sponsorship for the Real Men Read Program

We would love to expand this program and appreciate any assistance you, or your organization, can provide.

Thank you.

Sponsor books for a student = $15.00
Sponsor books for a entire CLASS = $400.00
Sponsor books for a entire SCHOOL = $2500.00

Would you like to be a Sponsor?

If Yes, you will be directed to a "Donate Page" once you submit this application.

Background Check Consent

I understand that by submitting this application, I am authorizing inquiries to be made concerning my suitability as a volunteer. This will include a check for any past criminal record. The information requested in this application and that, which may be subsequently obtained, will be used only for the purpose of determining my appropriateness as a volunteer. All information will remain confidential.

I hereby authorize Big Brothers Big Sisters of Northeast Indiana to conduct a background check as described and hereby release Big Brothers Big Sisters of Northeast Indiana from any and all liability related to the procurement or disclosures of any information provided by me or obtained about me in connection with my volunteer application.

I further direct and authorize any third parties who may be the custodians of or in possession of the requested information, to disclose such information in connection with this background check.

Thank You

Once you have filled out the above information hit the "Submit" button. Once you hit the "Submit" button you will be redirected to the donation page.

Thank you!