Heart of Illinois BBBS Volunteer Application

Non-Discrimination Policy

At Heart of Illinois Big Brothers Big Sisters, 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




Basic Information




input NA if none










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File can be a screenshot, PDF, or picture





File can be a screenshot, PDF, or picture
Contact Information

























Employer Information











Additional Information


NOTE for BBBS staff (delete before making the form live): You will need to update the drop down above with the corresponding options for your chapter. Then click on the blue Options button for the dropdown, go to the Calculations section, and input the corresponding Agency Location IDs into the boxes.









References and Background Check

Previous Experience










Volunteer Experience











Please provide at least three references below including:
  • Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other.
  • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
  • A friend or neighbor you have known for at least two years
Spousal/Familial Reference







Professional Reference







Minimum 1 year
Personal Reference







Minimum 2 years
I consent to and understand that:
  1. The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
  2. The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
  3. I am in no way obligated to perform any volunteer services;
  4. The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so; 
  5. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
  6. As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
  7. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.  
  8. I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
  9. I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);  
  10. It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.)
  11. I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
  12. I agree to timely communication and follow-up with all agency staff as required by the agency.

Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.  





Agency Weapons Policy





Please provide the name, age, and relationship to you for anyone else residing in your home.


Release of Information Authorization for Background Check

Confidentiality and Digital Platform Policies


Virtual Platform


Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).
In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

Child Safety Guidelines and Ground Rules for Volunteers                                                                     

Application Acknowledgement

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters.  I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.  

Contact Information