Safford High School Big Application

Thank you for your interest in being a High School Big! The following application

must be completed by the High School Student applicant and their Parent/Guardian.

Preliminary Questions

Who is filling out this form?

Please write the Matchforce Owner this should go under

Hidden Fields

Youth Contact Owner ID

To look up the owner's email for notifications

Youth Contact Owner Email

For notifications

Youth Contact ID

Youth Enrollment ID

Additional Youth Found

YesNo

Guardian Information

Guardian Contact ID

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Home Phone

Personal Email

Employer

Type NA if unemployed

Employer Phone Number

Type NA if unemployed

Job Title

Parent/Guardian Relationship Status

Guardian's Relationship to Youth

Number of Household Members

Family Information

Street Address

City

State

Zip Code

Emergency Contact

If we are unable to reach you (the High School Big applicant) who is someone we could call who always knows how to reach you?

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Relationship to High School Big Applicant

Additional Questions for the High School Big Applicant

Please complete this volunteer Big application packet to its fullest, including photo release, preliminary agreements, info forms, policies and agreements with my parent/guardian.

You will be asked to provide two reference contacts in this application. These are required as a part of the application.

Have you ever been charged with or convicted of a crime?

YesNo

What other youth organizations have you been involved with as a volunteer or employee?

What account names do you use on social media?

As a Big Brother/Big Sister Volunteer Applicant, I will provide or complete the following items:

Attend BBBSSA High School Mentor OrientationComplete Volunteer Mentor Application Packet: Photo Release, Preliminary Agreements, Info Forms, Policies and AgreementsReference Letters provided by an adult other than a parent/guardianAttend BBBSSA High School Mentor InterviewAttend BBBSSA High School Mentor Training

High School Big References

Please fill out at least two references to be contacted by Big Brothers Big Sisters of Southern Arizona. These references are an adult from your school that knows you well and can answer questions about your personality and interests. If you'd like to add another reference there is an option to do so below the second reference.

School Reference

Reference Name

Email

Phone Number

Relationship to You

Years Known

School Reference

Reference Name

Email

Phone Number

Relationship to You

Years Known

Preliminary Agreements

Please read and check off the following agreements for the BBBSSA High School Mentor Program

A parent or guardian must give their permission for me to participate in the program if I am under 18 years of age

I will be required to provide written references who may be contacted by mail, telephone or email

I must complete training before I can be matched with a Little

As a Big/Mentor, the Little(s) consider me a role model. While interacting with the Little(s), I agree to conduct myself responsibly and respectfully and to use appropriate language at all times.

You have reached the end of the application. We will need an "e-signature" to complete the application.

Parent/Guardian E-Signature

Full Parent/Guardian Name

As the parent/legal guardian, I give my permission for this student to participate in the BBBSSA High School Mentor Program

Parent/Guardian Signature - Typing my name below serves as my signature.

Full Student Name

To the best of my knowledge, the information provided is true and correct. I have read and understand all statements. I understand the application process and my responsibilities as a BBBSSA volunteer as defined by these statements. I understand that by typing my name below I am entering a Volunteer Agreement which obligates me to adhere to the responsibilities as stated above. I also understand that any breach of this Volunteer Agreement may result in being asked to leave the school campus or the ongoing activities and I may not return without BBBSSA approval. Further I understand that any breach of this Volunteer Agreement may result in my being asked to permanently leave the program, which could mean the loss of any earned class/course credits.

Youth/Mentor Signature - Typing my name below serves as my signature.

Staff

I, the staff member, have filled out this child application according to what the parent/guardian or other reliable source has provided me via printed handout or interview detail. I agree that I only copied what the Parent/Guardian has provided.

Staff Member Name

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say