BBBS SWLA Youth Referral

Inclusion Statement
Justice, Equity, Diversity, and Inclusion (JEDI) is an integral part of our values and mission. We recognize, affirm, and celebrate the diverse backgrounds, lives, and experiences of all of our stakeholders, including youth, families, donors, volunteers, and staff. 
Things to Know
This referral form is for all youth ages 6-18 that have been identified as needing a Mentor at their school or in the community. Once the completed referral form is received, BBBS Program Staff will review and connect directly with you/the referring professional if additional information is needed to enroll and match the youth(s) referred. Completion and submission of the Youth Referral form does not automatically accept and match the youth in one of our youth mentoring programs. Youth interview and needs assessment and parent/guardian authorization forms are required to complete the youth acceptance. If referring more than one child, please click the "Submit another referral for another youth" and include their information in the same form before clicking "SUBMIT".
Youth Information

This is the year the youth will graduate.

Parent/Guardian Information

Guardian Relationship to Child(ren)
What is the best method for us to contact you?
What is the best day of the week for us to contact you?
What is the best time of day for us to contact you?
Youth Information

Referring Person Information

Referring Factors: Why the youth needs a Big Mentor

Clicking submit does not automatically enroll and match your child(ren).  Program staff will reach out to you via email, phone, or text in order to complete your in-person orientation, schedule a parent/guardian and youth interview, and finalize all enrollment requirements before your child can be matched.