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

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.

I attest that the child I'm inquiring for:

Is between the ages of 6 and 14
Lives in Westmoreland or Fayette CountyDoes not have issues with aggressionIs not a danger to themself or to others

Youth Information

First Name

Last Name

Application Name

Concatenated from First + Last

Preferred Name

Birthdate

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?
School	Grade
School Account ID	12-Grade

Race/Ethnicity

American Indian or Alaska NativeAsian IndianBlack or African AmericanChamorroChineseFilipinoHispanic - CubanHispanic-Mexican,MexicanAmerican,ChicanoHispanic-Other Latinx or Spanish originHispanic - Puerto RicanJapaneseKoreanMiddle Eastern or North AfricanNative HawaiianOtherOther AsianOther Pacific IslanderPrefer not to saySamoanSome other race or originVietnameseWhite or Caucasian

Guardian's Relationship to Youth

The parent/guardian is this child's

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County

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. 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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