BBBSCR MAC Application

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. 

Basic Information








input NA if none








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Contact Information




























References and Background Check                                                                        Please provide at least two references. A reference from a Spouse/Spousal Equivalent or           Significant Other is required. Substitute a family member if no Spouse/Spousal Equivalent or   Significant Other. Employer references are permitted as well.

Personal Reference 1






Personal Reference 2






I understand that:
  1. The references whose information I have provided may be contacted by telephone or email.
  2. The information I provide may be used to conduct a background check, to include a driving records check, criminal background check, and other records where required by local, state, or federal law for volunteers working with youth. If matched, the information I provided will also be used to conduct an annual criminal background and driving records check for as long as I am matched. Continued involvement will be based on the information discovered.  BBBSCR will rerun my background check every 3 years, as long as I am associated with the program.
  3. I will be asked to provide my social security number.

Background Check

You will receive a separate email from eSign Genie with the consent form for your Background Check.

Mentoring Advisory Council Pre-Interview Questionnaire