Volunteer Inquiry Form

Non-Discrimination Policy

Big Brothers Big Sisters of the Midlands 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

Be at least 19 years of age
Be able to match with a Little within Lancaster and Seward counties
Have your own vehicle and have a valid driver’s license
Have current automobile insurance
Make at least a 12-month commitment to being matched in the program
Be able to meet with your Little 2-4 times per month for a total of at least 4 hours per month
Be able to meet our specific criminal history requirements

Contact Information

First Name

Last Name

Mobile Phone

Primary Email

Date of Birth

Gender

How do you identify?

Zip Code

How did you hear about us?

Please enter name of employer below:

Please enter the individual's first and last name:

Referral Detail ID

Big Couple Option

Are you interested in applying as a Big Couple with your significant other? In order to qualify as a Big Couple, you must be a married couple or two individuals in a committed relationship for three or more years who currently live together.

YesNo

Spouse/Partner's Information

**Please note that you and your spouse/partner will each have to complete the enrollment process separately in order to become a Big Couple. Your spouse/partner will receive a separate email to start their own enrollment once you have submitted this form.**

Spouse/Partner's First Name

Spouse/Partner's Last Name

Their Relationship To You

Spouse/Partner's Date of Birth

Spouse/Partner's Primary Phone

Spouse/Partner's Primary Email

**Please be aware that this is not an application. You will be required to submit a full application soon.**

**Please be sure to check your Primary and Junk email folders for any follow-up correspondences from the agency, Acuity, or FormAssembly.**

Contact Information