Youth Inquiry Form
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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
You may add additional youth by clicking on the "Add another child" button below.
First Name
Last Name
Preferred Name
Birthdate
Enter a date in the following format: mm/dd/yyyy
Gender
Please select...
Male
Female
Trans Male
Trans Female
Genderqueer/Nonbinary
Different Identity
Prefer not to say
Personal Pronouns
Please select...
He, Him
She, Her
They, Them
Other pronouns
How does the youth identify?
What pronouns does the youth use?
Youth Race/Ethnicity
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
Please check all that apply.
School
Grade
Please select...
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
12-Grade
What are the youth's top 3 interests or hobbies?
Anime, Manga, etc
Art (painting, drawing, pottery, photography, etc)
Board Games & TTRPGs
Content Creation
Cooking & Baking
Cosplay
Dance
DIY (fixing homes, cars, etc)
Electronics & Robotics
Fiber Arts (sewing, knitting, crochet)
Gardening & Plants
Hiking & Climbing
Music
Outdoor Hobbies (Fishing, Archery, Hunting, etc)
Playing Sports & Athletics
Reading
Snow Sports (ski, snowboard, etc)
Video Games
Watching Sports
Writing
Other
What is the hobby?
Parent/Guardian's Relationship to Youth
Please select...
Mother
Father
Step-Mother
Step-Father
GrandMother
GrandFather
Aunt
Uncle
Relative: Other
Foster Parent
Teacher
Counselor
Clergy
Probation Officer
Non-Relative: Other
Self-Emancipated Minor
Social Worker-Case Mgr
Application Name
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Mobile Phone
Personal Email
I prefer to be contacted by
Please select...
Phone
Email
Text
Family Information
Mailing Street Address
Mailing City
Mailing State
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Mailing Zip Code
County:
Please select...
Adams
Asotin
Benton
Chelan
Clallam
Clark
Columbia
Cowlitz
Douglas
Ferry
Franklin
Garfield
Grant
Grays Harbor
Island
Jefferson
King
Kitsap
Kittitas
Klickitat
Lewis
Lincoln
Mason
Okanogan
Pacific
Pend Oreille
Pierce
San Juan
Skagit
Skamania
Snohomish
Spokane
Stevens
Thurston
Wahkiakum
Walla Walla
Whatcom
Whitman
Yakima
Hidden Fields
Agency Location ID
How did you hear about us?
Always Known
BBBS Staff/Board Member
Community/Service Organization
Counselor/Therapist
Current/Former BIG
Foster Home
Google/Web Search
Neighbor/Friend
Print Media (Brochure, Flyer etc)
Relative
School
Social Media (Facebook, Instagram, etc.)
Special Event
TV or Radio
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Contact Information