MentorU Mentor Agreement

Personal Information




Notice and Authorization for Background Check
This is to inform you Big Brothers Big Sisters of the Inland Northwest, herein noted as BBBS or BBSINW, may obtain information about you and/or your history related to potential criminal activity. The report from authorized sources may include, among other information, arrest, conviction, and final board disciplinary decisions. BBBS may additionally obtain information concerning your background, character, medical conditions, employment, education, and military experience. Information obtained by BBBS will be used only for the purposes of assessing your suitability to become a volunteer and matching you with a student. 

As provided by State Law (RCW 43.43.830) a disclosure statement must be made by an applicant, and background inquiries may be made of certain civil adjudication's, conviction records or crimes against persons and disciplinary board final decisions prior to appointment to positions which have unsupervised access to children.  

Such inquiries may be made to state and/or federal law enforcement agencies. Information obtained from the disclosure statement, or from the background inquiries, will not necessarily preclude appointment, but will be considered in determining the applicant's character, suitability, and competence to person in the position applied for and may result in a denial of appointment. The use of the record of these inquiries will be restricted to the decision on your application and may be shared with the parent/guarding of the child you choose to match to. 

If you wish to be considered for a volunteer or staff position, you must complete and sign this application and associated forms. Failure to do so will disqualify you for any volunteer or staff appointment. 
Disclosure and Consent to Release of Information










Individual's Identifying Information 



















Required Documents


MentorU Volunteer Agreement

As a mentor with Big Brothers Big Sisters (BBBS), I understand I will be matched with a student whom I will communicate with using online communication tools. I understand I am making a commitment of at least one school year. As discussed in training with a BBBS staff member, I agree to:


1. I understand and agree the mentoring relationship is facilitated through MatchConnect, online communition tools, MentorU events.  I understand I will be responsible for reporting to the Site-Based Program Coordinator information regarding my communications with my student outside of MatchConnect. 


2. I understand and agree my student and I may not exchange phone numbers, email addresses, or home addresses unless approved by the Site-Based Program Coordinator. Therefore agree no contact in any form, including social media is allowed outside of the school or MentorU supervised setting unless approved by the Site-Based Program Coordinator.


3. I will not provide transportation for my student at any time.


4. I will complete all program-related evaluation forms and surveys.


5. I will notify the Site-Based Program Coordinator if I am unable to complete a weekly message or attend a scheduled event, as soon as possible.


6. I will follow all school and BBBS policies and guidelines, including safety reporting guidelines.


7. I will maintain confidentiality with my match. This includes using first names only when talking to others about my student and keeping my their family information private.


8. I will keep the agency informed of any changes in address, email, and/or phone number.


9. I will inform the agency if I am arrested and/or break any laws, regardless of if there is a conviction or not. The agency will review the arrest and the circumstance to determine the status of my match. Failure to inform the agency can result in immediate termination of the match. I understand a criminal background check will be conducted every three years while I am in an active match and I must submit the necessary authorization signatures when asked by staff.


10. I will consult with the Site-Based Program Coordinator  prior to giving my student any excessive gifts. 


11. I will never ask my student to keep any secrets. 


12. I will have regular bi-monthly communication with the Site-Based Program Coordinator. 


13. Be a positive role model. Therefore:


· I will not be intoxicated or impaired prior to or during the visit with my student.


· I will not use tobacco products, marijuana, alcohol, or any illegal substances in the presence of my student.

  

Any violation of the above stated may result in immediate termination of the mentor-student match.  I have read the volunteer policies outlined and will abide by them. 

MentorU Ground Rules
REPORT OF ABUSE
It is required to disclose the following to BBBS staff :
a. If any party of the match is a danger to himself/herself or someone else.
b. If any party of the match discloses physical, sexual, emotional abuse or neglect.

 DISCIPLINE
a. The Mentor is a friend, not a Parent/Guardian. It is appropriate for the Mentor to correct misbehavior within the context of the match relationship. However, parenting is left to the Parent/Guardian.
b. Physical discipline of the Mentee by the Mentor is never allowed. Likewise, any demeaning, shaming, threatening, exploitative behavior is also never permissible.

VALUES
It is important all match parties respect the different values and views each brings to the match relationship.

LEGAL RESPONSIBILITY
The Mentor assumes no legal responsibility resulting from the relationship with the Mentee. If a family problem arises, financial or otherwise, the Mentee or Parent/Guardian may contact the Site Based Program Coordinator for assistance.

OBEYING THE LAW
The Mentor is required to comply with all local, state and federal laws.
           
          DISREGARD OF GROUND RULES

Any disregard of the above ground rules or any willful misrepresentation of information given to the agency by the Mentor will result in immediate review and possible closure from the program.
Confidentiality Agreement
As a potential participant of Big Brothers Big Sisters (BBBS).  I understand I have access to confidential information about clients and families. I fully understand and accept the responsibilities inherent in my role to maintain the complete confidentiality of all personal information, documents and parties who are engaged in this partnership (collectively, the “Confidential Information”), including myself, BBBS and all its affiliates and employees, public figures as well as all children and families served by this partnership. The obligation of confidentiality persists indefinitely and is not limited to the period of time beginning with my participation in BBBS and ending at the close of my participation.

In order for BBBS to provide responsible and professional services, it is necessary for volunteers, clients and parent/guardians of clients to disclose personal information. BBBS respects the confidentiality of client/volunteer information. Confidentiality applies to written records, electronic records, voice, verbal statements, pictures (motion or still) and the use of client/volunteer’s name in agency publications. All records are considered property of the agency, not of agency staff, partner agencies, clients, parent/guardians or volunteers.

I further agree to the following terms:
  •  In the event an actual breach of confidentiality or a release of Confidential Information has occurred or if a situation which I reasonably believe may result in a breach of confidentiality comes to my attention, I agree to immediately notify the designated BBBS representative and/or any other appropriate BBBS staff member. I understand and agree I am required to report such breach or threatened breach of confidentiality regardless of whether the breach is caused by my own actions or by the actions of another person.
  • According to the Confidentiality Policy, information from client/volunteer records may only be shared with individuals/organizations as specified.
  • Identifying information regarding client/volunteer may be used in agency publications or promotional material only if the client/volunteer has given written permission.
  • Information shall be provided to law enforcement or courts only with a valid, enforceable subpoena.
  • Information shall be provided to BBBS if child abuse, exploitation or neglect is to be reported. 
  • If agency staff receives information indicating a client/volunteer may be dangerous to himself/herself or to others, steps shall be taken to protect the appropriate party, including a report to the law enforcement authorities.
  • When a child/volunteer is considered for a match, information is shared between the prospective parties. The identity of the parties is not revealed until after the parties agree to the match. Each party has the right to refuse the proposed match based on the anonymous information provided. Information shared may include: age, sex, race religion, education, interests, hobbies, marriage and family status, living situation, sexual orientation, reasons for applying to the program, expectations for match participation, a summary of the reasons an individual was chosen for the match, and all other information deemed relevant. The individuals to whom the information is provided shall agree not to share the information with any other person.
  • Certain outside bodies, including members of the Board of Directors, may have access to client/volunteer records for the purposes of program evaluation, audit, accreditation, and/or for purposes of operating and making available approved software, on-line sites and login portals. All such authorized persons and representatives shall enter into a Confidentiality Agreement before receipt of any information from client/volunteer records. 
Other than in the instances set forth above, information from client/volunteer records shall not be released unless accompanied by an authorized consent to release information form signed by the client/volunteer. If the client is under the age of 18, the consent to release information form must be signed by the student’s parent or guardian.

Thank you for your careful consideration and willingness to uphold the privacy and confidentiality of those participating in Big Brothers Big Sisters.
Social Networking Policy

It is the policy of Big Brothers Big Sisters that all agency volunteers who engage in the use of social networking, which includes, but not limited to social media, blogs, wikis, Twitter, Facebook, etc., agree:
  1. To remain a positive role model on all websites accessible to the public, recognizing the child assigned to you by BBBS, and their families may be able to view your information.
  2. To ensure internet postings respect the privacy and confidentiality of the child and families of BBBS by not disclosing any information that is confidential to BBBS, the child assigned to you by BBBS, the child’s parent/guardian, or any BBBS affiliates.
  3. To not share or reveal sensitive information about the child assigned to you by BBBS, including, but not limited to family situation, behavioral problems, medical diagnosis, etc.
  4. To respect the privacy of the family and the child who is assigned to you by consulting with the parent/guardian to gain consent before posting any pictures that include the child or any identifying information of any BBBS child or BBBS family.
  5. To speak respectfully about BBBS and those affiliated with BBBS and refrain from posting information that reflects negatively on BBBS, the child who is assigned to you, or the child’s parent/guardian.
  6. To abide by any other policy or procedure that BBBS may put into effect regarding social media and social networking.
  7. To adhere to all state and federal laws where applicable.
Mentor Contract
I have read and agree to the MentorU Volunteer Agreement and Ground Rules. 
By signing this contract, you agree to abide by the Big Brothers Big Sisters MentorU policies and standards set out in the Volunteer Agreement and Ground Rules. Failure to act in accordance with these guidelines can result in being unmatched from your mentee and dismissed from the program. 

I have read and agree to the BBBS Volunteer Confidentiality Agreement and Social Networking Policy.