BBBS of SWLA Youth Referral Form 

Inclusion Statement
Justice, Equity, Diversity, Inclusion (JEDI) is an integral part of our values and mission. We recognize, affirm, and celebrate the diverse backgrounds, lives, and experiences of all of our stakeholders, including youth, families, donors, volunteers, and staff.
Things to know
This referral form is for all youth ages 6-18 that have been identified as needing a Mentor at their school or in the community. Once the completed referral form is received, BBBS Program Staff will review and connect directly with you/the referring professional if additional information is needed to enroll and match the youth(s) referred. Completion and submission of the Youth Referral form does not automatically accept and match the youth in one of our youth mentoring programs. Youth interview and needs assessment and parent/guardian authorization forms are required to complete the youth acceptance. If referring more than one child, please click the "Submit another referral for another youth" and include their information in the same form before clicking "SUBMIT".
Youth Information










This is the year the youth will graduate.

Parent/Guardian Information




What is the best contact method you have found to be of use for contacting the parent/guardian?
Youth/Family Address






Referring Factors-Why the Youth needs a Big Mentor?

Contact Information