Big Brothers Big Sisters: High School Leadership Program Volunteer Application

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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. 

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Basic Information




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Contact Information




























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Additional Information




References and Background Check

Previous Experience










Volunteer Experience











Please provide at least three references below including:
  • Your parent OR a family member.
  • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
  • A friend or neighbor you have known for at least two years
Familial Reference







Professional Reference







Minimum 1 year
Personal Reference







Minimum 2 years
I consent to and understand that:
  1. The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
  2. The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
  3. I am in no way obligated to perform any volunteer services;
  4. The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so; 
  5. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
  6. As part of the enrollment process, I will be required to provide additional personal information, including completion of an in-person interview;
  7. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.  
  8. I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
  9. I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);  
  10. It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.)
  11. I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
  12. I agree to timely communication and follow-up with all agency staff as required by the agency.


Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.  





Why do you want to be a mentor in our program?



License and Insurance Information




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Address Line 1 City/State Zip/Postal Code From (Month/Year) To (Month/Year)
Please provide the name, age, and relationship to you for anyone else residing in your home.


Parent/ Guardian must review the following

Release of Information Authorization for Background Check

The information provided may be used to conduct a background check, including electronic media, driving records check, criminal background check and other records where required by local, state or federal law for volunteers working with youth. Due to the volunteer being a minor, parent/ guardian approval is required.


Parent/ Guardian must review the following

Confidentiality and Digital Platform Policies

I understand that the program is not obligated to match my child with a "Little" and that as part of the enrollment process, the prospective "Big" will be asked to provide additional information through an in-person interview. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law. I understand that incidents of child abuse or neglect, past or present, will be reported to proper authorities. I understand that certain relevant information about my child will be discussed with the volunteer who is a prospective match (i.e. demographic information, information relevant to volunteer preferences, and information relevant to child-safety and well-being).



We recognize that many of those involved in our programs use online social media. This has the potential to create a new and beneficial dimension to relationships with the children we serve. However, as with any interaction involving children, our foremost concern is child safety. Thus, we invite you to read through the following guidelines and consider how social media can be used in the healthiest, safest way possible. 

Child Safety & Confidentiality

  1. Using social media often involves creating content that is publicly accessible, meaning that anyone can view it. It is very important to keep child safety and confidentiality issues in mind when communicating on social media sites. Please refrain from providing identifying information about your Little. Examples of private information would be: full name, age, school site, current location, medical history, private family history, etc. 
  2. We do not wish to restrict individuals’ use of social media; however, we ask that you be aware of the child’s presence on the internet. We also expect volunteers to consider both the content you create as well as the content that becomes associated with you.  All information that is associated with your social media site could be accessible to your Little. 
  3. A good question to ask when considering the appropriateness of online content is “Would I expose my Little, in person, to this message or image of an outing?” As always, if you have questions, consult with your Match Support Specialist or appropriate BBBS staff.
  4. Privacy on the internet does not exist. Please consider your Little’s safety and privacy when sharing information via social media. A good rule of thumb is to not post content that you would not want to see in a newspaper.

Social Media and Parents or Guardians

  1. Before engaging in a social media relationship with your Little, you should first obtain permission from the parent or guardian. Doing this ensures that the parent or guardian is aware of the connection as well as creates the opportunity to discuss the nature of the relationship and any requests that the parent or guardian may have.
  2. Please exercise caution when considering engaging a parent or guardian in a social media relationship. This has the potential to alter the boundaries in your relationship. However, we do recognize that social media may, at times, be the best means of communication for some parents. 

Photos

  1. Please be sure to discuss with the parent or guardian what their preferences are for sharing photos of your Little through social media. If the parent or guardian has no issue with it, a verbal agreement is sufficient.

Positive Experiences with Social Media

  1. Online interactions can be a useful tool with which to build relationships with youth. By responsibly using social media yourself, you can set a great example for a child who is learning to socialize online.
  2. The use of social media can alert you of possible cyber-bullying and can lead to beneficial conversations about how a child perceives and reacts to social media content. Please seek resources from your Match Support Specialist if cyber-bullying is occurring for your Little. 
  3. While we always encourage you to use the most personal mode of communication possible (such as phone calls instead of texts), social media does offer new avenues to communicate conveniently with youth. Communicating via social media can help maintain a relationship when other forms of communication are impractical or impossible
  4. If you choose to communicate using social media, texts, or emails, please ensure that the child’s parent or guardian is kept aware of the interactions.

Representing Big Brothers Big Sisters of Dane County Online

  1. Regardless of your relationship with BBBS, we ask that you be mindful of how you represent our agency when using social media. 
  2. We ask that when referencing BBBS that you make it clear that you are not speaking on behalf of the agency in an official capacity. Official communications on behalf of BBBS and the use of logos or trademarks must be approved by the appropriate agency staff. 
  3. We also ask that you do not identify BBBS staff, clients, partners, or donors without their express consent. As always, if you are in doubt about the propriety of an online communication, please contact an agency representative to discuss at 608-661-5437.


Thank you for reviewing our Social Media Guidelines. We hope that you will continue to use social media to grow stronger relationships while using your discretion and sound judgment.


Parent/ Guardian must review the following

Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).
In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.


Parent/ Guardian must review the following

Child Safety Guidelines and Ground Rules for Volunteers                                                                      

If my child is matched with a Little Brother or Little Sister I agree to support my child’s match by reviewing the program and safety information given to me by Big Brothers Big Sisters, communicating with Big Brothers Big Sisters staff as outlined in expectations (which includes communication at least twice in the first year of the match), and immediately reporting any concerns I might have to Big Brothers Big Sisters staff.

1. I understand that my role as a Big is to meet with my little at least one hour per week during the school year and that our relationship is limited to the site setting.

2. I will not use alcohol or drugs during or prior to seeing my Little.

3. I understand that my Little and I CANNOT exchange phone numbers, email addresses, and or home addresses.

4. I will stay at the site with my Little.

5. I will not provide transportation for my Little at any time.

6. I agree to be in touch with my facilitator on a regular basis to discuss my match. I understand that it is a requirement. 

7. I understand that illness, vacation, or school holidays may sometimes prevent weekly contact. If I cannot keep my scheduled appointment, I will try to reschedule with my facilitator. 

8. I will follow BBBS child safety and reporting guidelines

9. I understand that meeting with my Little consistently is one of the most important things I can do as a Big. 

10. I will follow site rules. (i.e following site dress code, checking in with site office, cell phone policies). 

11. I understand that it is a requirement to speak to my facilitator prior to giving gifts to my Little. 

12. I agree to respect my Little's physical and emotional boundaries as well as their religious and cultural beliefs.

13. I understand the confidentiality policy and agree to abide by the policy.

14. I accept complete responsibility for my actions as a volunteer and agree to hold BBBS of Dane County free from all liability for my actions as  a volunteer.  


Parent/ Guardian must review the following

Application Acknowledgement

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters.  I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.  



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