MENTEE APPLICATION

Program Information

Thank you for your interest in the Massachusetts Bay Community College Mentor Program through Career Services, in partnership with Big Brothers Big Sisters. This application is designed to help the program team learn about your academic path, career interests, goals, availability, and preferences so we can make thoughtful mentor matches.

The mentor relationship is intended to support career exploration, education planning, networking, professional confidence, and preparation for internships, jobs, or transfer opportunities. While the program will do its best to consider your interest and preferences, an exact match cannot be guaranteed.

Please answer as honestly and completely as you can. Questions marked with an asterisk are required, all others are optional and may be skipped. Information shared in this form should be used for program administration, matching, and student support.

Hidden Fields

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Contact Owner Full Name

Student Contact Information

First Name

Middle Name (full)

Please provide your Full Middle Name - No initials or abbreviations. Write N/A if you do not have a middle name.

Last Name

Maiden/Alias

Leave blank if none

Preferred Name

Birthdate

VOLUNTEERS MUST BE AT LEAST 18 YEARS OLD TO APPLY

MassBay Student ID Number

We'll use your contact information to send updates about your program enrollment. While you're matched with a mentor, our program staff will also reach out to support. Please provide contact information you check regularly.

Personal Email

MassBay (alternate) Email

Work Email

Preferred Email

Mobile Phone

Home Phone

Work Phone

Other Phone

Example: Work phone if it is available for incoming calls.

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

May Career Services and your mentor text this number for program purposes?

YesNo

I understand that I am required to respond to communications from program staff and that failing to do so may affect my eligibility to participate in the program.

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Relationship

Parent/Guardian Information

The information below is required by our program management platform. We will not contact the person you submit unless they are listed as en Emergency Contact of Reference.

Parent/Guardian Contact ID

First Name

Last Name

Parent/Guardian Relationship

Preferred Email (None)

Preferred Phone

Consent, Data Sharing, and Final Review

I understand that information from this form may be reviewed by MassBay Career Services and approved program partners for mentor matching and program administration

YesNo

I give permission for appropriate information from my application to be shared with my assigned mentor after a match is confirmed

YesNo

If I am under 18 at the time of enrollment, I undestand that additional parent or guardian consent may be required

YesNot applicable

Please confirm that the information you provided is accurate to the best of your knowledge

Yes No

Photo Consent Release

I irrevocably grant Big Brothers Big Sisters, MassBay, their affiliates, successors, partners, sponsors, donors, and authorized third parties the right to use my name, image, likeness, biographical information, recordings, writings, and artwork (the "Released Material"), in original or modified form, for advertising, publicity, marketing, fundraising, and related purposes, in any media now existing or later created, worldwide, in perpetuity, at their sole discretion — without further consent, compensation, or royalty to me.

I assign all rights, title, interest, and copyright in the Released Materials, including the right to register and enforce those copyrights. I understand these materials become property, that only BBBS and

MassBay may authorize third-party use, and that I have no right to review or approve them before use.

I acknowldge BBBS and MassBay have no obligation to use the Released Materials, and no liability to me for any editing, alteration, or distortion resulting from their use.

I release BBBSA, MassBay, its affiliates, employees, agents, and partner companies from all claims, demands, and liabilities — including compensation, defamation, invasion of privacy, or other rights violations — arising from the exercise of these rights or the appearance of the Released Materials in any publication or production.

Publicity and promotional materials for Big Brothers Big Sisters and MassBay are conducted in a variety of forms. May we use your name, image, likeness, appearance, or basic biographical information in these materials?

Disclosure of Non-Discrimination Policy

I understand that Big Brothers Big Sisters and MassBay are committed to the inclusion of all people, supporting all identities.

I acknowledge that Bigs and Littles will not be excluded from the program based on race, ethnicity, immigration status, gender identity, sexual orientation, ability, or religious preference.

Match Support Specialists may try to accommodate matches based on similar affinities. However, except for matching like gender identities, which is currently a requirement, all Bigs and Littles may be matched with individuals who identify as members of any race, ethnicity, immigration status, sexual orientation, ability, or religious preference.

I recognize that Big Brothers Big Sisters and MassBay prioritizes inclusion as a core value.

If you feel this policy has not been followed or wish to appeal a decision related to it, you may contact our Chief Executive Officer or our Board Chair to request a review.

By signing this agreement, you agree to these terms as a condition of participation in the program.

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say