BBBS Southern Lake Michigan Region 

Youth Application

Thank you so much for your interest in enrolling your child into Big Brothers Big Sisters Southern Lake Michigan Region mentoring program! 

We appreciate your desire for your child to have a mentor "Big."  Our goal is to provide youth with a caring adult who can be a part of their support system.  All Bigs are volunteers, and because we rely heavily on volunteers, the length of time before your child will be matched can vary.

We also match based on mutual interests, age, and locations. Unfortunately, this means some youth wait longer than others, but it gives each match the best chance to build a friendship with their Big. As soon as you submit this application, your child will be placed on our waiting list. While you are waiting for your child to be matched, please keep us updated with any changes to your address and phone number. This is very important because we will use this information to reach out to you to schedule an intake interview. If we cannot reach you, your child's application will have to be closed. 

FOR ELKHART COUNTY RESIDENTS: We have a partnership with the Boys and Girls Clubs of Elkhart County. Once a child is added to our waiting list, they can have a free scholarship to attend one of the clubs! Please visit for more information or call (574) 534-5933 to learn how your child may attend one of the four B&G Club locations in Middlebury, Elkhart, Goshen, and Nappanee.  This scholarship is for the clubs only, not Kids Care.


Please don't hesitate to reach ou tto us with any questions or concerns. If you need resources for your family, please email

Thank you!

BBBS Enrollment Team


Non-Discrimination Policy

Big Brothers Big Sisters Southern Lake Michigan Region follows a non-discrimination policy that prohibits exclusion of potential volunteer Bigs, youth, parents/guardians, board members, or agency staff on the basis of race, color, religion, age, pregnancy, gender, gender identity or expression, sexual orientation, national origin, ancestry, disability, veteran status, marital status, or any other protected class.

Youth Basic Information

Please enter full middle name. Not initials.

*If youth does not have any other names, please enter N/A

Youth must be at least 6 years old at time of application.

Use CTRL click to multi-select all that apply.

Legal Guardian Information

Please enter full middle name. Not initials.

We serve the following counties in Indiana: Elkhart, St. Joseph, La Porte, Porter, Marshall, Newton and Jasper.

We serve the following counties in Michigan: St. Joseph, Berrien, Cass.

If you live outside of our service area, please visit to find the agency that serves your area. If you have questions, please exit the application and email our Enrollment Team at

If none, please leave blank.
Youth Emergency Contact Information


Health and Well-Being
At BBBS SLMR, we care deeply about the safety, health and overall well-being of children we serve and their families. The following questions will help us to identify where your family may want some support and how we can help. These questions also help us identify where your child's Big may also need support while they are matched with your child. 

Answering "Yes" to this question will not affect your child's acceptance into the BBBS program.

Personality/Interests: Traits that will help us match your child with a volunteer who we think will be compatible based on similar interests and personality type. 

Home Life

Other Siblings and Relatives in the Program
Please choose this child's relationship to the following people:

Additional Information

Program Interest
We have two types of programs to choose from.

The Community Based Program is a program where the Big coordinates with you to pick up your child and take on outings in the community. Community Based matches will do things like play at the park, go to the movies, grab a bite to eat, go to sports games - you get the idea. They will always make sure the outing they have planned is okay with you.

If you and your child are interested in the Community Based Program, please select COMMUNITY.

The Site Based Program is a program where the Big will meet your child at their school or their after school program and hang out there. The match does not leave the site. BBBS SLMR has to have a partnership with the site for this program.

If you and your child are interested in the Site Based Program please select SITE.

Match Preferences 
The following questions are designed to help us make the best, most successful match for you, your child, and a potential volunteer. We do this by exploring your preferences in a match, as well as the preferences of your child and prospective volunteers to ensure that everyone feels comfortable. Big Brothers Big Sisters is an inclusive organization. We welcome and enroll Bigs, Littles and family members of all races, religions, marital status, genders and sexual orientations. We are committed to making sure our programs are inclusive of all youth, families, volunteers, and staff.  The goal of the matching process is to provide high quality, long-lasting mentoring relationships which have the maximum benefits for a child while providing a fulfilling experience for the volunteers.

*Big Couples are in a stable, long term relationship. Your child would have 2 Bigs who will spend time with them instead of the traditional one -to-one match.

*Big Families are entire families that volunteer. Oftentimes, Big Families consist of a married couple and their child/children.

Gender and Sexual Orientation

Participation Agreement
As the legal guardian of my child, I give full permission for the following:

1. For my child to participate in the Big Brothers Big Sisters Program.

2. For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, has permission to transport my child to events and match activities.(Community-Based match only) 

3. For the school to provide social and academic information about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports);

4. To have my child participate in an in-take interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout their time in the program containing questions about school, home life, and personal interests.

5. To have my child talk with a Big Brothers Big Sisters staff person about personal safety.

6. BBBS staff may provide contact information for me and my child to the volunteer. (Community-Based match only)

7. For Big Brothers Big Sisters staff to meet with my child at their school and/or afterschool program center to conduct an interview and/or match support.

8. For my child’s Big to meet with them at their school.


I understand that the program is not obligated to match my child with a volunteer and that as part of the enrollment process, I will be asked to complete needed surveys to track my child's progress in the program. If my child is enrolling into the Community-Based mentoring program, I will be asked 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 and with exceptions noted.  I understand that incidents of child abuse or neglect, past or present, must 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).


I certify that all of the information on this form is true and correct and that all income is reported.  I understand this information is being given for the receipt of federal funds, that the information on this application may be verified, and that deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. I understand this information will not affect my child's qualification for the program.


I do hereby release the organization and its employees, agents, members, volunteers, and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating in said program and activities, including but not limited to any liability to any right of action that may occur to such child directly, or to me as their guardian. I understand that this information may be shared with the school or with partnership agencies when applicable.


If my child is matched with a Big, 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 once a month in the first year of the match), and immediately reporting any concerns I might have to Big Brothers Big Sisters staff.

Confidentiality Agreement

1. All information that I may encounter about any child, child’s family, volunteer Big, the volunteer Big's family or anything else of a confidential nature about any child or volunteer in any way connected with Big Brothers Big Sisters WILL BE HELD CONFIDENTIAL.

2. Any information that reveals or tends to reveal the identity of any person who is the subject of the record WILL BE HELD CONFIDENTIAL.

3. The identity of any person who contributes information to the subject record WILL BE HELD CONFIDENTIAL.

4. The results of any inquiry into school records or medical records of any description WILL BE HELD CONFIDENTIAL.

5. I will NOT discuss any information that I am privileged to receive with any other person without the verbal or written permission of the program staff.

6. I will only release prior approved information to the individual to whom I have been given permission to release the information.

7. I agree to hold all related information confidential and, except as I may be legally required, I will NOT disclose or release it to any individual or corporation at anytime.

8. I understand that Big Brothers Big Sisters agrees to hold all related information confidential and, except as we may be legally required, we will NOT disclose or release it to any individual or corporation at anytime.

Media Release

Picture of your Child (Optional)
We occasionally spotlight children on our waiting list in our Agency Newsletter or on our social media pages in an effort to recruit volunteers Bigs.

It is helpful for us to have a picture of a child who would love to have a Big with the Call To Action to apply to become a volunteer mentor. With your permission, we would like to be able to use a photo of your child and provide a brief description of their interests and personality in these recruitment materials.

This is not required and if you choose to opt out, it will not effect your child's eligibility for our programs nor will it impact the length of time your child is on our waiting list.  

Social Media Policy

A.            Purpose & Scope of Policy


When used appropriately, BBBS believes that social media is a tool that can be utilized in the communication and strengthening of the bond between the Big, Little, Parent and agency. Social Media includes, but is not limited to Facebook, Twitter, Pinterest, Instagram, Myspace, blogs, buzzfeeds, snapchats and other sites.


As a condition of being a Volunteer Big, volunteer Bigs must read, understand, and agree to abide by this Policy.  Failure to adhere to this Policy may result in the early termination of a match relationship.


B.            Affiliate Position on Use of Social Media


BBBS encourages volunteer Bigs to using age appropriate Social Media with Littles, Little’s parent/guardian(s), family members in accordance with the guidelines of this policy.


BBBS requires volunteer Bigs and parent/legal guardian(s) of the Little to actively opt-in or opt-out of participation in social media with regards to the match relationship. In order for the Big to post any picture or name, the primary parent/guardian’s consent must be given. Otherwise, only generic information may be used.


If either party does not consent, the other party may not specifically identify or communicate with said party within the context of social media.


If a Parent/Guardian or Big chooses to not opt-in and sign the Photo/Social Media Release form, examples of prohibited activities include:


                -Posting photos of person


                -Tagging or Listing of name in a post or photo


                -Checking in at particular locations, specifically identifying the Big or Little


C.            Overall Monitoring of Safety, Confidentiality & Privacy


If a Big or Parent/Guardian chooses to use social media within the context of the match relationship, the Big and Parent/Guardian shall agree to the following:


a.            Terms of use of specific Social Media sites


Upon opting in, each Volunteer Big/Parent/Guardian will certify that s/he has reviewed the terms of use/service and any applicable privacy policy and /or provisions on minors of the Social Media sites that they intend on using with the Littles.


b.            Privacy settings


Upon opting in, each volunteer Big, if using Social Media with their Little, has customized their Social Media settings to ensure that no personal information is viewed by the general public, in order to protect the Little from searches by or contact from the general public.


c.             Monitoring for legal, respectful, appropriate content


Upon opting in, each volunteer Big will monitor their Social Media sites to ensure that all posts and posted materials, whether by the volunteer Big or a third party, are respectful, legal, and appropriate.  If a party observes any social media interactions that are disrespectful, illegal, or inappropriate material, the other party is instructed to contact MSS immediately.


d.            Enhanced restrictions for access to site by Little


Upon opting in, each volunteer Big will use Social media privacy controls and settings to restrict accessibility of the Little to age appropriate content, including wall comments.


e.            Process for reporting misuse, endangerment


Upon opting in, each volunteer Big understands what to do in the case of viewing any information on the Little’s Social Media site that may endanger that Little’s health, safety, and welfare.  Volunteer Big should contact MSS immediately and understand that it is required by Indiana State law to report child abuse to law enforcement personnel.


f.             Confidentiality / Privacy of Little/Little’s family


Upon opting in, volunteer Bigs should not disclose personal information about the Little or their family. Information might include but are not limited to: address, phone number, first and last names, private locations, occupations, other members of the family or problems and concerns that would required match support conversations. Volunteer Bigs are permitted to share match activities, success stories and positive feedback about the program.


g.            Access to information and reposting from the affiliate’s site


Whether opting in or opting out, volunteer Bigs are not allowed to repost content from any “Bigs Only” pages on BBBS’s Facebook page or private section on the BBBS website, particularly if the content not available to the general public. However, volunteer Bigs are permitted and encouraged to share and repost information from the BBBS’s public Facebook page and website, especially promoting fundraising and recruitment efforts of the agency.


h.            Promotion and attribution


When a participant posts something regarding the agency, BBBS requests that participants consider the impact (positive or negative) of such posts. Volunteer Bigs should represent that their opinion(s), belief(s) and statements are personal, and do not represent the opinion(s), belief(s) or statements of BBBS.


D.            Compliance


a.            Investigation non-compliance


BBBS will not actively monitor the volunteer Bigs Social media sites; however, if there is a complaint or inquiry, or BBBS becomes aware of a potential violation of this policy or any other, then BBBS has the right to access the volunteer Big’s Social Media site for compliance purposes.


b.            Consequences of non-compliance


Based on the severity of non-compliance, consequences may range from putting the match on hold to termination of match relationship. If at any time BBBS observes anything that it suspects might put the child’s safety at risk, the agency will exhaust all methods to protect the safety of the child.


E.            Process for distribution of Social Media Policy


This policy will be distributed to volunteer Bigs and Parent/Guardians at the time of Enrollment. A copy of the Photo/Social Media will also be available at that time.

Use of Social Media Consent

Consent for Surveys and Training

Consent to Release Information

Please review the information in the application BEFORE clicking Submit. When you click Submit and you are directed to a "Thank You" message, your child's application was received.

Please DO NOT click the back arrow and resubmit the application. 

If you need additional assistance, please email Katie at

Thank you! 
Electronic Signature

After clicking SUBMIT you will be prompted to sign this form and enter your email address. Then you will receive an email with a confirmation and a copy of this document. Thank you!