Logo3School-based Youth Application

Program Information 
Welcome to the Big Brothers Big Sisters of the Tennessee Valley school-based enrollment application. This program pairs elementary school students — known as "Littles" — with high school student volunteer mentors for weekly one-on-one sessions during the school day in a safe, supervised school setting. As a parent or guardian, you are applying on behalf of your child. By completing this application, you are indicating that you believe your child would benefit from a mentoring relationship and that you support their participation in the program. Your child will meet with their assigned high school mentor once per week during the school day.
Hidden Fields
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Youth Information
Enter a date in the following format: mm/dd/yyyy
This is the year the youth will graduate.
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Guardian Information
Type NA if unemployed
Family Information
Physical Address
Existing Household Members
Please choose this child's relationship to the following people:


Emergency Contact
Non-Discrimination Policy
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. 

Confidentiality Policy

Big Brothers Big Sisters of the Tennessee Valley respects the confidentiality of client and volunteer records and, with the exception of situations listed below, shares information about clients and volunteers only among the agency professional staff.

 

All records are considered the property of the agency and not the agency workers or clients or volunteers themselves.  Records are not available for review by the clients or volunteers.

 

  1. Information will be released to other individuals or non-BBBS organizations only with the client or volunteer's written consent.
  1. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the clients or volunteers request otherwise.
  1. For purposes of program evaluation, audit, or accreditation, and with the prior approval of the Board of Directors, certain outside bodies such as Big Brothers Big Sisters of America may have access to client and volunteer records.
  1. Members of the Board of Directors or evaluators appointed by the Board have access to client files upon authorization of the Board of Directors.
  1. Information will be provided to law enforcement authorities only upon the issuance of a valid and enforceable subpoena.  However, general verbal information i.e., your affiliation with our organization and information that may be found, for instance, in BBBS publications may be given upon request of law enforcement authorities.
  1. Information shall be provided to an agency's legal counsel in the event of litigation or potential litigation involving the agency.
  1. State law mandates that suspected child abuse be reported to the appropriate authorities.
  1. If an agency worker receives information indicating that a client or volunteer may be dangerous to himself or herself or to others, necessary steps may be taken to protect the appropriate party.  This may include a medical referral or report to the local law enforcement authorities.
  1. At the time a child or volunteer is considered as a match candidate, information is shared between the prospective match parties.  The information about the volunteer may include such items as:  age, sex, race, religion, interests, hobbies, marriage, family status, sexual orientation, living situation, etc.  Information about the child may include such items as age, sex, race, religion, interests, hobbies, family situation, etc.

Guidelines and Grounds Rules for Parents/Guardians

Parent/Guardian:


Be an active partner. Working together, parents and caregivers, volunteer mentors, and BBBS staff plan activities and opportunities that can have a powerful and positive impact on your child. Here is what you can expect as a partner in this school-based match.


Stay in communication with Match Support. For site-based programs, BBBS staff will contact you multiple per year to get your perspective on the match, observations, and any questions. If concerns arise at any time, staff are available to provide support and guidance. Please note that for safety purposes, BBBS may suspend or terminate any match where consistent communication is not occurring.


Participate in scheduled assessments. BBBS uses assessment data to guide the match, identify resources your family may need, evaluate program effectiveness, and ensure your child's safety. You and your child will be asked to participate in these assessments at key points throughout the year.


Stay informed about match activities. Since this is a school-based program, all mentor meetings take place on school grounds during the school day in a supervised setting. When your child returns home, talk with them openly about their experience and share any observations or questions with your Match Support Specialist.


Call us. If you need resources, have safety concerns, or need to discuss the match at any time, contact your Match Support Specialist. You are always encouraged to reach out between scheduled contacts.


Respect boundaries. BBBS educates volunteers, families, and students about the importance of maintaining appropriate boundaries within the mentoring relationship. Volunteer mentors are here to be a consistent, caring presence for your child during the school day. Please remember that volunteers should not be asked to provide transportation, purchase items, care for siblings, or perform any services for the family.


Follow all policies, procedures, and ground rules. Adhering to BBBS policies is critical to your child's safety and the health of the mentoring relationship. These will be reviewed with you during your enrollment interview and orientation.


Support your child's mentoring relationship. The time your child spends with their mentor can be an invaluable experience. Supporting scheduled meeting times, getting to know the volunteer, and talking with your child about their experience are great ways to strengthen the match.

Authorization for Release of Information

I give my consent to allow any counseling, therapy, or medical service my child has, is, or will be seeking to release confidential information to Big Brothers Big Sisters of the Tennessee Valley for my child. 

The purpose of this information exchange is to solicit service for my child from Big Brothers Big Sisters of the Tennessee Valley (BBBSTV). Further, I give consent to continued authorization to discuss my child’s situation as it relates to receiving services through BBBSTV. If my child receives such services, the information exchange will be to keep BBBSTV apprised of my child’s status and development within the community as well as other issues which may affect Big Brothers Big Sisters of North Alabama’s ability to provide their services to my child. BBBSTV staff and/or volunteer agree to maintain the confidentiality of any information released.

 

 

I understand the following information may be released: diagnosis/ prognosis, medications, family relationships, and behavior in the community, from my child’s mental or medical professional.

 

 

This authorization shall expire upon written notification by me; or by termination of services by me, or Big Brothers Big Sisters of the Tennessee Valley. A copy of this holds the same authority as the original.

Social Media Consent

I hereby grant Big Brothers Big Sisters of the Tennessee Valley (BBBSTV) and its affiliates permission to identify my youth in any BBBSTV publication or production of media, in any form (digital, electronic, video, audio, photo, etc). I acknowledge that all rights, title, and interest to the media will belong to BBBSTV.

BBBSTV and its affiliates may use, reproduce, exhibit, or distribute any production of the media, in all form, for any purpose that the agency deems appropriate. This includes, but not limited to, promotional and advertising efforts.

 

Mandatory Reporting

I , do hereby verify that Big Brothers Big Sisters of the Tennessee Valley staff has notified me that any volunteer matched with my child is now a Mandatory Reporter for the State. I understand that with the volunteer being a Mandatory Reporter, that any known or suspected abuse or neglect of a child must be reported to the proper authorities.

Smoking Cessation

For information about smoking cessation, please visit the CDC.gov. 

Contact Information