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.

Contact Information

Personal Email

Work Email

Preferred Email

Mobile Phone

Cell Phone Provider:

Is it okay to text you?

YesNo

Work Phone

Work Phone Extension

Home Phone

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Are you interested in learning about additional ways to contribute to the Big Brothers Big Sisters Mission?

YesNo

Pease check all the interests that apply.

Becoming a donor
Helping to recruit volunteers
Volunteering at agency events for matches, Littles, waiting-list children, etc.
Volunteering at agency fundraising eventsInviting BBBS to speak at a company, church, organization, or other group of which I am a member

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

First Name

Last Name

Email

Phone

Relationship to you

Years known

Personal Reference 2

First Name

Last Name

Email

Phone

Relationship to you

Years known

I understand that:

The references whose information I have provided may be contacted by telephone or email.
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.
I will be asked to provide my social security number.

I accept the terms and conditions

American Indian or Alaska Native	Asian Indian
Black or African American	Chamorro
Chinese	Filipino
Hispanic - Cuban	Hispanic - Mexican, Mexican American, Chicano
Hispanic - Other Latinx or Spanish Origin	Japanese
Korean	Middle Eastern or North African
Native Hawaiian	Other
Other Asian	Other Pacific Islander
Samoan	Vietnamese
White or Caucasian

MAC Application

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.

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

MAC Application

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.

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

Mentoring Advisory Council Pre-Interview Questionnaire

Background Check

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