Youth Application

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. 
Hidden Fields
To look up the owner's email for notifications
For notifications
Youth Information
Enter a date in the following format: mm/dd/yyyy

Hold CTRL+F to select multiple

This is the year the youth will graduate.
Guardian Information
Type NA if unemployed
Family Information

Physical Address
Emergency Contact
If we are unable to reach you, who is someone we could call who always knows how to reach you?

Additional Questions




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





























We will make every effort to honor your preferences for your child's mentor. BBBS does not discriminate on the basis of race, ethnicity, gender, gender presentation, marital status, sexual orientation, or religion.

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Bigs in Blue is Big Brothers Big Sisters of America’s one-to-one mentoring program that connects youth with police and other law enforcement professionals in communities across the nation, building strong, trusting, and lasting relationships.
Sometimes the best place to help a child realize their potential is at a school, community center, or corporate workplace. Whether mentoring occurs in the classroom, gym, or conference room, it’s all about developing a friendship, providing guidance and inspiring children to reach their potential. Students from a partnering college meet with their Littles at lunchtime or after school.

Expectations
  • Minimum of a one year commitment
  • Meet during the school year, with the opportunity to keep in touch through a writing campaign during summer break
  • Programs are supervised by Big Brothers Big Sisters staff or school/agency contact
You can give a child the invaluable gift of friendship by spending just a few hours together a couple times per month. To be a positive role model can be as simple as playing a board game, going to the playground, or participating in a BBBS activity. Just as your options are unlimited, so is a child’s potential.

Expectations
  • Make a one year minimum commitment to your Little
  • Make face-to-face contact with your Little at least twice per month
  • Participate in ongoing phone contact with Big Brothers Big Sisters staff throughout the duration of your match
Sometimes the best place to help a child realize their potential is at a school, community center, or corporate workplace. Whether mentoring occurs in the classroom, gym, or conference room, it’s all about developing a friendship, providing guidance and inspiring children to reach their potential. Must be at least 15 and a sophomore at a participating high school. Programs take place in an elementary or middle school during study hall or after school.

Expectations
  • Minimum of a one year commitment
  • Meet during the school year, with the opportunity to keep in touch through a writing campaign during summer break
  • Programs are supervised by Big Brothers Big Sisters staff or school/agency contact
mentor2.0 is a program developed in partnership with iMentor that brings technology-enriched, one-to-one mentoring to high school students.

Through collaborative efforts with schools, companies, and individuals, mentor2.0 provides high-impact mentoring relationships aimed at giving high school students the support and guidance they need to graduate high school and succeed in post-secondary education.

Expectations
  • Minimum 24 month commitment
  • Attend one in-person 2 hour event per month at Brashear High School
  • Participate in weekly online communication with your mentee via a web platform
Sometimes the best place to help a child realize their potential is at a school, community center, or corporate workplace. Whether mentoring occurs in the classroom, gym, or conference room, it’s all about developing a friendship, providing guidance and inspiring children to reach their potential. Students from Pittsburgh Public Middle Schools are matched with adult mentors from the community. Mentors visit once a week for an hour during the school year. Times vary depending on location.

Expectations
  • Minimum of a one year commitment
  • Meet during the school year, with the opportunity to keep in touch through a writing campaign during summer break
  • Programs are supervised by Big Brothers Big Sisters staff or school/agency contact
Sometimes the best place to help a child realize their potential is at a school, community center, or corporate workplace. Whether mentoring occurs in the classroom, gym, or conference room, it’s all about developing a friendship, providing guidance and inspiring children to reach their potential. Littles are matched with employees from our corporate partners who help foster college readiness and career development.

Expectations
  • Minimum of a one year commitment
  • Meet during the school year, with the opportunity to keep in touch through a writing campaign during summer break
  • Programs are supervised by Big Brothers Big Sisters staff or school/agency contact
Sports Buddies is a version of our Community-based Mentoring Program that matches adult mentors with youth who have a shared interest in sports, fitness, or just being active.

Expectations
  • Make a one year minimum commitment to your Little
  • Make face-to-face contact with your Little at least twice per month
  • Participate in ongoing phone contact with Big Brothers Big Sisters staff throughout the duration of your match
Big Siblings is a version of our Community-based Mentoring Program that matches adult LGBTQ+ mentors with youth also in the LGBTQ+ community. BBBS will host monthly group activities for matches in this program to attend. 

Expectations
  • Make a one year minimum commitment to your Little
  • Make face-to-face contact with your Little at least twice per month
  • Participate in ongoing phone contact with Big Brothers Big Sisters staff throughout the duration of your match
Level Up is an embedded mentoring program model at Dickson STEAM Middle School and South Brook Middle School. In this program, a Mentoring Specialist will work with small groups of students on topics related to sense of belonging, vision for future, avoidance of risky behaviors, and social emotional learning. All programming will occur at the school, facilitated and supervised by Big Brothers Big Sisters staff. 

Parent/Guardian Agreement

By checking the box below and providing my signature at the end of this form, I give permission:
  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, to personally interact with and transport my child to events and match activities, if applicable and allowed by program type;
  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 intake interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout their time in the program containing questions about school, home life, the match, and personal interests to evaluate and improve program services;
  5. To have my child talk with a Big Brothers Big Sisters staff person about personal safety;
  6. For BBBS staff to provide contact information for me and my child to the volunteer.
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 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). 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 qualification for the program. I, on behalf of myself and my child, completely release and forever discharge Big Brothers Big Sisters of Greater Pittsburgh and its employees, agents, members, volunteers and all other persons on its behalf, together with any successors in interest, heirs, attorneys, agents, representatives, and all persons acting by, through, under, or in concert with them from all known and unknown charges, complaints, claims, grievances, liabilities, obligations, promises, controversies, damages, actions, causes of action, suits, rights, demands, costs, losses, debts, penalties, fees, wages, attorneys’ fees and costs, and punitive damages of any kind or nature whatsoever, whether known or unknown, which I may have, or may have had, against Big Brothers Big Sisters of Greater Pittsburgh, arising from any participation 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 intend and understand that this release and discharge is to be interpreted and enforced so as to provide the broadest release and discharge possible as may be permitted by law. 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 Brother or Big 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 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 Policy

The BBBS of Greater Pittsburgh respects the confidentiality of all clients’ (defined as caregiver/guardian/parent, child, and volunteer) records and, with the exception of situations listed below, shares information about clients only among the agency professional staff.  In order to provide service, which is in the best interest of the children served by the program, information from outside sources, including confidential references must be assessed along with information gained from the clients.  It is the agency’s responsibility to protect the confidentiality of reference responses and counseling reports by not disclosing their content to a client applicant.  Therefore, the agency may decide not to disclose the reason for rejection to the client.   

 

All records are considered the property of the agency and not the agency workers or clients themselves.  Records are not available for review by the clients.  Clients must sign this summary statement indicating an understanding of the agency’s confidentiality policy and agree to program participation under the guidelines before being accepted into the program.   

 

Information will be released to other individuals or non-BBBS organizations only with the client's written consent.  Identifying information regarding clients may be used in agency publications or promotional materials unless the client requests otherwise.  For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may have access to client records.  Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.  Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.  Information shall be provided to an agency's legal counsel in the event of litigation or potential litigation involving the agency. 

 

State law mandates that suspected child abuse be reported to the appropriate authorities. If an agency worker receives information indicating that a client may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party.  This may include a medical referral or report to the local law enforcement authorities. 

 

At the time a child or volunteer is considered as a match candidate, information is shared by the agency with the prospective match parties.  The information about the volunteer may include such items as:  age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, gender identification, living situation, etc.  Information about the child/parent may include such items as: age, sex, race, religion, interests, hobbies, family situation, sexual orientation, gender identification, living situation etc. 

 

I understand that some information, including opinions of the BBBSPGH staff, may be shared with parents of a potential Little or a potential volunteer.  I hereby give my authorization for such limited release and use of information that may otherwise be deemed confidential pursuant to the policies contained in the complete confidentiality policy statement and I release and waive any liability against the organization, all Big Brothers Big Sisters personnel and the Board of Directors of said organization.   

 

Contact Information