Youth Inquiry
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.
Attestations and Acknowledgements
Big Brothers Big Sisters of the Laurel Region enroll
youth between the ages of 6 and 14 years old
who live in Fayette or Westmoreland County, and who are facing some sort of adversity.
In order to keep our volunteers safe, we cannot accept children who are aggressive, or who are a danger to themselves or others.
If accepted into the program, the Parent/Guardian must agree to form a partnership with the agency and mentor, and complete monthly check ins.
By submitting this form, you attest that the child you're inquiring for:
Is between the ages of 6 and 14
Lives in Westmoreland or Fayette County
Does not have issues with aggression
Is not a danger to themself or to others
By submitting this form, you acknowledge that:
This is an inquiry and not an application. A caseworker will be in contact to discuss eligibility requirements and the enrollment process.
Mentors at Big Brothers Big Sisters are not behavioral therapists, counselors, or crisis intervention. They are encouraged to form a bond more like a friendship. They are a confidante and a role model.
The agency has the right to accept or deny participants or close a match at any time. Parents/Guardians will be provided with an acceptance or non-acceptance letter after the application period. Providing a reason for non-acceptance is against our policy.
Mentors are all volunteers. Being accepted into the program and placed on the waitlist does not guarantee the youth will be matched with a mentor before they age out of the program.
Youth Information
First Name
Last Name
Application Name
Concatenated from First + Last
Preferred Name
Birthdate
Gender
Please select...
Male
Female
Trans Male
Trans Female
Genderqueer/Nonbinary
Different Identity
Prefer not to say
Personal Pronouns
Please select...
He, Him
She, Her
They, Them
Other pronouns
How does the youth identify?
What pronouns does the youth use?
School
Grade
Please select...
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
School Account ID
12-Grade
Race/Ethnicity
American Indian or Alaska Native
Asian Indian
Black or African American
Chamorro
Chinese
Filipino
Hispanic - Cuban
Hispanic-Mexican,MexicanAmerican,Chicano
Hispanic-Other Latinx or Spanish origin
Hispanic - Puerto Rican
Japanese
Korean
Middle Eastern or North African
Native Hawaiian
Other
Other Asian
Other Pacific Islander
Prefer not to say
Samoan
Some other race or origin
Vietnamese
White or Caucasian
Guardian's Relationship to Youth
The parent/guardian is this child's
Please select...
Mother
Father
Step-Mother
Step-Father
GrandMother
GrandFather
Aunt
Uncle
Relative: Other
Foster Parent
Teacher
Counselor
Clergy
Probation Officer
Non-Relative: Other
Self-Emancipated Minor
Social Worker-Case Mgr
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Mobile Phone
Personal Email
I prefer to be contacted by
Please select...
Phone
Email
Text/SMS
Family Information
Mailing Street Address
Mailing City
Mailing State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
County
Please select...
Fayette
Westmoreland
How did you hear about Big Brothers Big Sisters?
Referral Detail ID
**Please note that this is an inquiry to receive more information. It is not an application.
**We only enroll youth between the ages of 6 and 14.
**Big Brothers Big Sisters of the Laurel Region has the right to accept or deny participants or close a match at any time.
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