Family Application

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12 Characters
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Youth Information

First Name

Last Name

Birthdate

Gender

Personal Pronouns

How does the youth identify?

What pronouns does the youth use?

Guardian Information

Guardian's Relationship to Youth

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Gender/Gender Identity

How do you identify?

Parent/Guardian Personal Pronouns

What pronouns do you use?

Contact Preference

Preferred Phone

Phone number

Work Phone Ext

Best Time to Call

Preferred Email

Additional Questions

Does your child know that you are applying for the program?

YesNo

Does your child want to participate?

YesNoUnsure

Do you anticipate any significant life changes over the next year, or have you had any in the past year? Examples of significant life changes include moving, job changes, or changes in family size or dynamics.

YesNo

Life Changes Description

What is the primary reason for you wanting your child to have a Big?

What strengths does your child have that a Big might be able to help grow?

What are some of the needs your child has (examples could be emotional, social, behavioral, or academic) that a Big may be able to help them with?

Referral Source

How did you hear about Big Brothers Big Sisters?

Please describe:

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