Youth Application

A Note Before You Begin...

Are you enrolling a youth that identifies as 'male'?

YesNo

Unfortunately, we are not enrolling male youth at this time due to an overwhelming number of Little Brothers waiting to be matched and so few Big Brothers/Couples to match them with. We are working hard to increase their number over the next few months.

Please click the link below to leave your contact information and we will reach out when we're ready to re-open enrollment.

CLICK HERE

Thank you and we apologize for the inconvenience.

Before you begin...

What You Need To Complete The Application

Please make sure you have the following ready before you proceed:

Contact information for your emergency contact; and caseworker (if applicable)
Information about your child's medical history
Your personal or professional schedule to help you decide on a good date/time to schedule you and your child's interview with us.
TIME -- The application should take about 10-15 minutes to complete, but please make sure that you have ample time to complete it especially if you're enrolling more than one child. There is an option to save your form if you're unable to complete the application(s) in one sitting.

If enrolling more than one child, you will need an application completed for each of them.

You will be able to schedule your interview online via Acuity Scheduling after submitting your child's or children's application(s).

Eligibility Requirements

You will need to meet the following criteria before moving forward:

Youth are between the ages of 7 and 14 at the time of enrollment

Resides within Lancaster and Seward counties

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-Lincoln and abide by the Agency's policies and guidelines

Must not be involved in another mentoring program (ex., Teammates, etc.)

Should you have questions about the enrollment criteria, you may reach out to our Enrollment Coordinator, Jalin Gerdes, at 402-665-0475, or at jgerdes@bbbslincoln.org

Foster Care Youth

If you are enrolling a youth in foster care, do NOT proceed with this application until you have been in contact with our Enrollment Coordinator.

If our Enrollment Coordinator has completed your pre-enrollment process, you may proceed with completing the application.

Jalin Gerdes | Enrollment Coordinator

Phone: 402-665-0475 | Email: jgerdes@bbbslincoln.org

Girl Scouts Partnership

Girl Scouts Spirit of Nebraska has a partnership with Big Brothers Big Sisters Lincoln which allows Little Sisters (all grades) to join Girl Scouts and participate in activities and events free of charge! Siblings (kindergarten through 12th grade) can join as well. This applies to all Big Brothers Big Sisters Lincoln mentees and their siblings.

Through enriching experiences and activities, Girl Scouts discover their values, connect with those who share their vision, and take action to make the world a better place. Girl Scouts is the preeminent leadership development organization for girls, providing abundant opportunities for every girl to do something and be someone amazing!

Girls and their families can choose how to participate, this can be with a troop or as an individual. There are many girls who choose to participate solely by attending programs or a camp. All girls can sell cookies if they desire.

While participating in programs and camps is available at no charge, your girl does need to be registered to participate.

Is this opportunity something that interests the girl(s) in your household?

YesNo

Great to hear!

After you've submitted your application, a representative from Girls Scouts Spirit of Nebraska will contact you within the next month for more information on how to get started.

No problem!

If you ever change your mind, you can contact us or Girl Scouts Spirit of Nebraska at any time.

BBBSL Agreements

Non-Discrimination Policy and Agreement

Big Brothers Big Sisters Lincoln 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.

We, at the agency, expect you will join us in adhering to this policy as an advocate for your child and their potential mentor. We serve a diverse community with individuals from many different backgrounds and values and want to respect those differences as well as protect the safety of our youth, parent/guardians, and volunteers.

I have read the above policy and agree to its terms.

Non-Disclosure Policy and Agreement

BBBSL’s Program staff will communicate with parents/guardians throughout the enrollment and match support process about the importance of BBBS maintaining confidentiality with anything your child may share in order to maintain their trust and safety.

I have read the above policy and agree to its terms.

Parent/Guardian Agreement

As a parent/guardian in the Community-Based Mentoring Program of Big Brothers Big Sisters Lincoln, I agree to the following: I agree to let my child meet with his/her Big the required 2-4 times per month for a minimum of four (4) hours per month for a minimum of one year.

I agree to maintain open, consistent communication with my child’s Big and Big Brothers Big Sisters Lincoln staff on a regular basis to ensure the safety of my child, to discuss any concerns or problems and to report any changes I see in my child.

I agree to keep my child’s Big and Big Brothers Big Sisters Lincoln staff aware of any changes in contact information to ensure the continued support of my child’s match.

I agree to provide money for outings my child has with their Big. If I have any concerns about the amount of money being spent, I will address this with Big Brothers Big Sisters Lincoln staff immediately.

I agree with the above statements and will do everything I can to help my child develop a positive mentoring friendship with their Big.

Confidentiality Policy Agreement

I have read and understand Big Brothers Big Sisters Lincoln's Policy on Confidentiality of Records (click link to download a copy or request a copy from Agency staff), and I permit participation of my child in the program under the conditions it sets forth. Furthermore, I hereby release Big Brothers Big Sisters Lincoln (its officers, directors and employees) from any and all claims, damages, causes of actions, liability, cost and expenses (including attorney fees) that I have, or might hereafter have, for the sharing of confidential information in compliance with Big Brothers Big Sisters Lincoln's Policy on Confidentiality of Records:

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' confidentiality policy. I agree to the conditions set forth.

Promotional Authorization

I give permission for Big Brothers Big Sisters Lincoln to use photographs, slides, video tapes, films, television/radio tapings and/or pictures of my child for the purpose of promoting the Big Brothers Big Sisters mentoring program. I also understand that I may revoke this authorization at any time by giving written notice to Big Brothers Big Sisters Lincoln. Thirty (30) days must be allowed from date of receipt of written notice for revocation to take effect.

Opt InOpt Out

Virtual Platform

Big Brothers Big Sisters of America has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation requires your permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform.

Community-Based Program Agreement

By signing this form, I give permission:

1. For my child to participate in Big Brothers Big Sisters Lincoln’s community based mentoring program;

2. For the volunteer matched with my child, who has been screened and approved by Big Brothers Big Sisters, to transport my child to events and match activities;

3. For the school to provide social and academic information about my child to Big Brothers Big Sisters (report cards, behavior reports, etc.);

4. To have my child participate in an intake interview conducted by Big Brothers Big Sisters staff and complete questionnaires throughout his/her time in the program pertaining to topics such as school, home life and personal interests;

5. To have my child talk with a Big Brothers Big Sisters staff person about personal safety; and

6. For Big Brothers Big Sisters 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 information through an in-person interview. I understand that the information I provide during the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted. I understand that incidents of child abuse or neglect, past or present, must 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 (for example, 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 to the best of my knowledge 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 child’s qualification for this program.

I do hereby release the organization and its employees, agents, members, volunteers and all other persons on its behalf from any and all liability for any damage or injury which such child might sustain while participating 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 his/her parent/guardian. I understand that this information may be shared with my child’s school or with partnership agencies when applicable.

If my child is matched with a Big Brother, Big Sister or Big Couple, I agree to support my child’s match by reviewing the program and safety information given to me by Big Brothers Big Sisters Lincoln, communicating with Big Brothers Big Sisters staff as outlined in expectations (which includes communication at least once a month during the first year of the match) and immediately reporting any concerns I might have to Big Brothers Big Sisters staff.

I have read the above agreement which defines my responsibilities as the parent/guardian of a Little. By signing this application, I agree to abide by them as long as my youth is in the program and I understand that BBBS has the right to close my youth’s match at any time.

Additional Enrollments

Each child that you are planning to enroll will need their own application completed. Do you need to submit an application for another child?

YesNo

Next Steps

After completing your e-signature on the next page, you will be re-directed back to a new Youth Application for another child that you would like enrolled in the program.

You may click 'Submit' below to proceed.

Next Steps

After completing your e-signature on the next page, you will be re-directed to Acuity Scheduling to set up your interview with us. Please choose the interview option that best suits the number of children that you are enrolling.

You will only need to schedule one interview unless you are enrolling four or more children.

You may click 'Submit' below to proceed.

Name:	Relationship:
App record ID	contact record ID