Welcome back to the Big Brothers Big Sisters Program!

To reserve your child's space within the program, please complete the form below. Questions can be directed to your Big Brothers Big Sisters of Connecticut Program Specialist.

Remaining questions can be directed to the Senior Manager of Program Facilitation Melissa Novak, at MelissaN@ctbigs.org or via phone 203.600.4521.

Participant Info

Youth Full Name

Parent/Guardian Full Name

Parent/Guardian Phone Number

Parent/Guardian Email

Which school partner does the youth participant attend?

Program Availability & Logistics

The next few questions will address your availability for program and the resources you have to access sessions.

Do your child attend an afterschool program?

YesNo

Are there specific times of year when this schedule may change? (this can be due to sports, pre-planned vacations etc.)

Are there any medical conditions such as allergies to food or medication you would like us to be aware of?

Questions About Your Mentor Relationship

These next few questions will be about the type of mentoring relationship either you or your child would like to experience this year.

Is there anything specific (academic, social, etc...) a mentor in which a mentor may be able to provide support?

Have there been any major changes in you (or, your child's life) since they were last enrolled in our programming that you would like us to know about?

Are there any questions that you (or, your child) have about program this year? Please submit your question below and one of our facilitators will get back to you OR contact our Senior Manager of Program Facilitation Melissa Novak, at MelissaN@ctbigs.org or via phone 203.600.4521.

Contact Information