Youth Inquiry Form
Welcome!
Non-Discrimination Policy
Big Brothers Big Sisters of Siouxland will not discriminate against potential volunteers or youth based on race, religion, national origin or citizenship status, gender, gender identity or expression, sexual orientation, disability or marital status.
Eligibility Requirements
You will need to meet the following criteria before moving forward:
Youth are between the
ages of 6 and 13
at the time of enrollment
Resides in the Big Brothers Big Sisters of Siouxland's service area (which includes the counties: Woodbury, Plymouth, Union, Dakota)
Will reside in the area for
at least 12 months
to commit to the program
Be able to meet with their Big 2-4 times per month for a total of at least 4 hours per month
Youth shows a desire to be matched in the program
Have a custodial parent/guardian that will demonstrate a supportive and cooperative attitude toward BBBS and abide by the Agency's policies and guidelines
Should you have questions about the enrollment criteria, you may reach out to our Enrollment Specialist, Aldo Moreno
Call/Text:
712-333-6139
Email: Amoreno@bigbrothersbigsisters.com
Parent/Guardian Orientation
Thank you for your interest in learning more about joining the Big Brothers Big Sisters Community-based Program!
Please watch the Parent/Guardian Orientation video and complete the brief questionnaire below it
to review what you've learned in the video
. Make sure that you find the time and space to do so that will provide you the least amount of distractions.
If you have specific questions about our program or enrollment process, please contact our Enrollment Specialist, Kenda Windeshausen
Call/ Text: 712-333-6139 Email: Wkendra@bigbrothersbigsisters.com
Parent/Guardian Orientation Questionnaire
Question 1: As the parent/guardian to my child’s match, I am expected to:
Please select...
a) Make sure I’m paying for all activities and that my child is calling his Big every week.
b) Commit to supporting my child’s match, and maintain great communication with the Big and BBBS staff.
c) Wait for the Big to call us, the Big will pay for all activities, and use the Big as a means of punishment for my child.
Question 2: Which of the following statements is true:
Please select...
a) My child will be matched with the 1st available Big.
b) My child and I will be able to choose a Big from a list of available volunteers in the area.
c) The agency will match my child with a Big based on personality, shared interests, and preferences.
Question 3: How long will it take for my child to be matched?
Please select...
a) My child will be matched a couple of days after our interview is completed.
b) My child will be matched during the next solar eclipse.
c) My child could be waiting months to allow time for BBBS to find the RIGHT Big for them.
Question 4: Who do I contact at BBBS when issues arise in my child's match or I want to share a positive moment between my child and their Big?
Please select...
a) The Enrollment Specialist
b) The Executive Director of Big Brothers Big Sisters of Siouxland
c) My assigned Match Support Specialist
**Please note that your results may be considered in the acceptance of your child/children.**
Youth Information
First Name
Last Name
Preferred Name
Application Name
Concatenated from First + Last
Is this youth in the foster care system?
Yes
No
Is this youth between the ages of 6 and 13?
Yes
No
Unfortunately, we are unable to continue with the enrollment of this youth. Our program requires those enrolling to be 6-13 years of age.
Birthdate
Gender
Please select...
Male
Female
Trans Male
Trans Female
Genderqueer/Nonbinary
Different Identity
Prefer not to say
Write In
How does the youth identify?
Personal Pronouns
Please select...
He, Him
She, Her
They, Them
Write In
What pronouns does the youth prefer?
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Guardian's Relationship to Youth
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
FC Inquiries to FC-EC
Mobile Phone
Personal Email
I prefer to be contacted by
Please select...
Phone
Email
Zip Code
Social Worker/Case Manager Contact Information
Social Worker/Case Manager First Name
Social Worker/Case Manager Last Name
Social Worker/Case Manager Phone
Social Worker/Case Manager Email
Name of Service Organization (ex. St. Francis, Lutheran Family, Child Saving Institute, etc.)
Additional Information
How did you hear about Big Brothers Big Sisters?
Type to search (please be specific)
Were you referred to us by a Parent/Guardian, Big, staff, or board member that is currently in our program?
Yes
No
If so, please enter their full name here, if possible.
Referral Detail ID
What's Next?
Next, our enrollment specialist will reach out to you with a link to our online application. You'll then need to complete the application and schedule an interview with us.
The enrollment process is self-paced and takes about 10 minutes to complete (not including the interview with our staff, collection of additional counseling forms, and completion of online training). If you're ready to move forward, continue on to complete the application by clicking "Submit" below.
Please let our enrollment specialist know if you have any questions or concerns.
Thank you for your interest in
Big Brothers Big Sisters of Siouxland,
and
we look forward to meeting you soon!
**Please check your primary AND junk folders for any follow-up emails from BBBS, FormAssembly, or Acuity Scheduling moving forward.**
Contact Information