BBBS Youth Application

Big Brothers Big Sisters of Greater Cincinnati

BBBS Youth Application

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.

Youth Information

First Name

Last Name

Application Name

Concatenated from First + Last

Preferred Name

Birthdate

MM/DD/YYYY

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?
School	Grade

Race/Ethnicity:

Has the youth had any involvement in the juvenile justice system?

YesNo

Parent/Guardian Information

Guardian's Relationship to Youth

The parent/guardian is this youth's

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County:

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

Child Living Situation:

Household Income:

Does the youth have a parent with military experience?

YesNo

Does the youth have an incarcerated parent?

YesNo

Does your child receive free or reduced lunch at school?

YesNo

Do you have any dogs?

YesNo

If yes, please describe the breed.

Contact Information

2400 Reading Road | Cincinnati, Ohio | 513.421.4120 | bigsforkids.org