BBBS Volunteer Application

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Mission: create and support one-to-one mentoring relationships that ignite the power and promise of youth.

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics and we value our differences. Participant eligibility shall be determined without regard to race, ethnicity, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or (dis)ability.

Application

Our Program serves youth in Thurston, Mason, Lewis, Grays Harbor and Pacific Counties. Do you reside in Thurston, Mason, Lewis, Grays Harbor or Pacific County?

YesNo

Thank you for your interest in Big Brothers Big Sisters. Please visit the Big Brothers Big Sisters of America website at Big Brothers Big Sisters of America to find an agency near you.

This application will take 20-30 minutes to complete. Depending on the program type, you will need the following items to complete the application:

Picture/digital copy of your driver's license or photo ID
Picture/digital copy of your driver's insurance
Phone number and email address of references: personal, spouse/familial, employer, and any youth-serving organizations you have volunteered or worked with in the last 5 years.

Which program(s) are you interested in applying for? If you have not attended an orientation, you will learn more about programs then. You can change your program interest at any time.

Community-based (outings into the community; 2-4 times a month)Site-based (meeting at a school or site with BBBS staff present to support; weekly during the school year)Career Mentoring Exploration (workplace mentoring with high school students; monthly during the school year)*only available if your workplace is participating*I am not sure or I am interested in all.

Workplace and industry:

Do you have any concerns about your ability to fulfill the year commitment required of mentors

Please describe your concerns regarding the commitment:

Basic Information

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

First Name

Middle Name

Last Name

Maiden or Previous Names

input NA if none

Preferred Name

Birthdate

Social Security Number

This is secure and encrypted.

Gender

How do you identify?

Personal Pronouns

What are your pronouns?

Race/Ethnicity

American Indian or Alaska Native	Asian Indian
Black or African American	Chamorro
Chinese	Filipino
Cuban	Mexican, Mexican American, Chicano
Japanese	Korean
Middle Eastern or North African	Native Hawaiian
Other	Other Asian
Other Latinx or Spanish Origin	Other Pacific Islander
Puerto Rican	Samoan
Vietnamese	White or Caucasian

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Driver's License

Do you have a driver's license or state-issued photo ID?

Driver's License Number

Driver's License State

Driver's License Expiry

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Residence History

Have you lived outside of Washington state in the last 5 years?

YesNo

Please list all of the different cities and/or states in which you have lived outside of Washington in the last 5 years.

City

State

From

Contact Information

Personal Email

If you don't have an email, enter swwabigs.program@gmail.com

Alternate or Work Email

Preferred Email

Cell Phone

If no cell phone, enter home number.

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, how do you prefer to be contacted?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing County

Other Mailing County

Mailing address is different from physical address.

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

Employer Information

Employment Status

Employer/School

Occupation (if student, select "student")

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

Is it okay to call at work?

YesNo

Additional Information

Level of Education

Year Degree Obtained

Have you served in the military?

Branch of military

Dates of service

Character of separation/discharge:

Relationship Status

Sexual Orientation

Sexual Orientation Write-in

Do you speak any languages other than English?

YesNo

Which languages do you speak?

Spanish	African Languages (Swahili, Bantu)
American Sign Language	Arabic
Asian: Other	Chinese
Creole	Dutch
Eastern European (Czech, Slovak)	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	No Preference
Nordic	Persian
Portuguese	Russian
Turkish	Lao

Previous Experience with BBBS

Have you previously applied to be a Big Brother or Big Sister here or anywhere else?

When?

Where?

Were you matched in the program you applied for?

YesNo

How long were you matched?

References

Please provide at least three references. A reference from a Spouse/Spousal Equivalent or Significant Other is required. Substitute a family member if no Spouse/Spousal Equivalent or Significant Other.

Spousal/Family Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Professional Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Personal Reference

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Have you held a volunteer or paid position where you worked with children in the last five years? (for example counselor at a camp, babysitting, nannying, coaching, etc.)

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Volunteer Experience

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Policies, Consents & Releases

Confidentiality Policy & Mandatory Reporting

In order for Big Brothers Big Sisters of Southwest Washington to provide a responsible and professional service to clients, it is necessary for volunteers, clients, parents or guardians to divulge extensive personal information about themselves and their families. The agency 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’s professional staff. The right to confidentiality applies not only to written records but to video, film, photographs, or use of volunteer or client’s name in agency publications. All records are considered the property of the agency and not the agency workers, clients or volunteers themselves. In order to provide a service which is in the best interest of the children served by the program, information from outside sources, including confidential references, shall be assessed along with information gained from the clients or volunteers. Clients and volunteers shall be provided, at the interview, with a copy of this statement on confidentiality along with a list of the expectations, which define the limits of confidentiality. Clients and volunteers shall sign a statement that they have read and understands the agency policy on confidentiality and agrees to the program participation under guidelines it has set forth.

Limits of Confidentiality

Information may be released to other individuals or organizations only upon the written consent by the client or volunteer.
Identifying information regarding clients and volunteers may be used in agency publications and/or promotional materials if the client or volunteer has given permission.
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. These outside organizations shall be required to respect the agency policy on confidentiality. Outside parties shall be required to use information only for the purpose stated in the approval action of the Board of Directors. Known violations of agency confidentiality policy will be reported to the supervisor of the individual involved and appropriate disciplinary action shall be requested.
Members of the Board of Directors have access to client files only upon authorization by formal motion of the Board of Directors. The motion shall state who shall be authorized to review records, the specific purpose for such review and the period of time during which access shall be granted. Members shall be required to comply with the agency policies on confidentiality and may use the information only for purposes stated by the approved action of the Board of Directors. Known violations shall be reported to the Board President. A violation of the agency’s confidentiality policy by a Board Member shall constitute adequate cause for removal from office.
Information shall only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena or as required by statute, with exception to number 8 and 9 (see below).
Information shall be provided to an agency’s legal counsel in the event of litigation or potential litigation involving the agency. Such information is considered privileged information, and its confidentiality is protected by law.
State law mandates that suspected child abuse shall be reported to the appropriate authorities (Child Protective Service). All workers are responsible for staying abreast of such reporting requirements of the irrespective jurisdiction and shall always comply with mandated procedures.
If an agency worker receives information indicating that a client or volunteer may be dangerous to themselves or others, necessary steps shall be taken to protect the appropriate party. This may include a medical referral or a report to the local law enforcement authorities or a mental health professional, as appropriate.
It is the position of the agency to not “out” a young person in regards to their gender identity, gender expression or sexual orientation that is confidential to the youth or the parent/guardian. The information will be kept confidential with those whom the child chooses to tell.
As a volunteer Big, I understand that personal information about the Little I am matched with, and/or their family, should be held in confidence. I understand that this confidentiality policy does not include my case manager or other Big Brothers Big Sisters agency staff who I might speak with regarding any circumstances of my match.
Information that I share with people I know will be limited to information about the types of activities that my Little and I do together and will not reveal personal information that my Little shares with me. When speaking to people I know about my Little, I will only use their first name and will not identify where my Little lives.

Mandatory Reporting: I understand that I am a mandatory reporter of child abuse and neglect. If my Little shares any information or I suspect abuse or neglect, I will contact my Match Support Specialist immediately.

Agreement to Protect the Confidentiality of Match Information

I agree to keep the information discussed with me regarding a potential (Big or Little) match confidential. I will not discuss this information with any person other than Big Brothers Big Sisters of Southwest Washington professional staff. I have read and understand that the above document which states the agency policy with respect to confidentiality of client and volunteer records as well as Mandatory Reporting. I agree to program participation under the conditions it sets forth.

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' confidentiality policy and Mandatory Reporting. I agree by the conditions set forth.

Mutual Respect Policy

Our Commitment
Big Brothers Big Sisters of Southwest Washington is committed to creating safe, positive, and meaningful mentoring relationships that support the growth, development, and well-being of every youth we serve.

A successful match depends on everyone involved: youth, parents/guardians, volunteers, and BBBS staff, all working together as a team. By participating in the program, we agree to communicate respectfully, follow program policies and safety guidelines, maintain appropriate boundaries, and work with BBBS staff to address questions or concerns.

The following Mutual Respect Policy outlines the expectations for all volunteers and parents/guardians participating in the BBBS program.

As a Volunteer or Parent/Guardian, I agree to:

1. Put the youth’s safety and well-being first.
I will make decisions that prioritize the physical and emotional safety of the youth and will promptly communicate any safety concerns to BBBS staff.

2. Treat everyone with respect.
I will treat youth, volunteers, parents/guardians, staff, and other program participants with courtesy, dignity, and respect. I will not use threatening, abusive, insulting, or demeaning language or behavior.

3. Communicate appropriately and respectfully.
I will communicate honestly, directly, and respectfully, even when there is a disagreement or concern. I understand that concerns about the match or program should be brought to the Match Support Specialist so they can be addressed appropriately.

4. Work collaboratively with BBBS staff.
I will maintain regular communication with my Match Support Specialist and participate in required match support contacts. I will communicate significant concerns, changes in circumstances, or questions rather than allowing problems to escalate. The Match Support Specialist is the primary link between the youth, parent/guardian, volunteer, and agency.

5. Follow BBBS policies, procedures, and safety guidelines.
I will follow all policies and guidelines provided through BBBS training and throughout my participation in the program. I understand that these requirements are in place to protect the youth and support healthy mentoring relationships.

6. Maintain appropriate boundaries.
I will respect the role of the volunteer, parent/guardian, youth, and BBBS staff. I understand that a Big is a mentor and friend; not a babysitter, disciplinarian, counselor, financial provider, or taxi service.

7. Respect the youth’s relationship with their mentor.
Parents/guardians agree to support the development of the match and will not prevent the youth from participating in match activities as a form of discipline. Volunteers agree to respect the parent/guardian's role and family rules.

8. Obtain and respect required permissions – Community Based ONLY
Volunteers will obtain parent/guardian approval before outings and will follow all BBBS requirements regarding activities, transportation, home visits, and other match activities. Parents/guardians will provide timely approval or communicate concerns about proposed activities.

9. Maintain appropriate communication with the youth.
I will communicate with the youth in ways that are appropriate for their age and consistent with BBBS policies. I will never ask a youth to keep secrets from their parent/guardian or BBBS staff.

10. Respect confidentiality and privacy.
I will protect the privacy of the youth and family and will not share confidential information (including photos) about the match or family without appropriate authorization. I understand that confidentiality does not prevent BBBS from taking action when there is a concern about a youth's safety or well-being.

11. Respect differences and individual identities.
I will respect the youth and family regardless of their background, culture, socioeconomic circumstances, religion, gender, sexuality, disability, communication style, or other individual differences. I will not make racist, sexist, classist, homophobic, or other discriminatory comments or jokes.

12. Use appropriate behavior and language around youth.
I understand that I am a role model and that my words and actions can influence the youth. I will model appropriate behavior and will not engage in behavior, conversations, or activities that are inappropriate for a young person.

13. Follow BBBS child safety requirements.
I understand that overnight activities are never permitted and that certain activities require prior written approval or are prohibited. Volunteers will follow all transportation, supervision, substance-use, physical-contact, and home-visit requirements outlined by BBBS.

14. Report safety concerns and suspected abuse or neglect.
I will immediately communicate concerns about a youth's safety or well-being to BBBS staff and follow required reporting procedures. I understand that BBBS volunteers are mandatory reporters of suspected child abuse or neglect.

15. Respect the volunteer’s time and commitment.
Parents/guardians understand that volunteers are giving their time to support the youth and will make reasonable efforts to communicate about schedules, cancellations, and changes in plans. Volunteers will make reasonable efforts to be consistent, dependable, and communicate when plans change.

16. Avoid inappropriate financial expectations.
I understand that volunteers are not financially responsible for the youth or family. Match activities should generally be free or low-cost, and expectations around expenses should be discussed in advance.

17. Address concerns through the appropriate channels.
If I have a concern about the match, another participant, a BBBS employee, or a program decision, I will bring that concern to BBBS staff rather than confronting, threatening, insulting, or attempting to resolve the matter inappropriately with another participant.

18. Support healthy match closure.
I understand that matches eventually end or transition for a variety of reasons. I agree to work with BBBS staff to handle match closure thoughtfully and respectfully, recognizing the importance of the relationship to the youth.

19. Understand that participation is a privilege and a shared responsibility.
I understand that BBBS may take action when a participant does not follow program expectations, policies, safety requirements, or this Mutual Respect Policy. Depending on the circumstances, violations may result in additional intervention, suspension, or closure of a match or participation in the program.

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' Mutual Respect Policy. I agree by the conditions set forth.

Media Release

Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. By selecting below I authorize Big Brothers Big Sisters to identify me in the media as a Big Brother or Big Sister using my full name. I also give permission for the use of other forms of media including but not limited to written word, photo, video, social media, and voice recording.

Yes, I agree to have my media used for BBBS. No, I do not want my media used for BBBS.

Accident Policy

In the event that a Little is involved in some type of accident involving an injury during a match activity, it is imperative that you notify your Match Support Specialist within 48 hours.

Big Brothers Big Sisters of Southwest Washington has an excess accident policy, which may provide certain benefits. Benefits payable are determined by the following information.

If the injured is currently covered through a separate health insurance policy, that policy will act as primary insurance. The excess accident policy provided by Big Brothers Big Sisters may act as a secondary insurance. This means that the injured will have to submit the claim to their own insurance company prior to submitting a claim to Big Brothers Big Sisters accident insurance.
If the injured party is not currently covered by any other health insurance policy, the excess accident policy provided by Big Brothers Big Sisters may act as primary insurance.

I acknowledges that I have read and understood the above information on the benefits provided by Big Brothers Big Sisters of Southwest Washington.

Consent to References & Background Checks

I consent to and understand that:

The references and youth serving-organization I listed may be contacted by mail, telephone, email, or in-person;
The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
I am in no way obligated to perform any volunteer services;
The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so;
Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted below.
I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities;
I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);
It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.).
I agree to timely communication and follow-up with all agency staff.
At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges and convictions related to any civil, domestic, or criminal occurrences. I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.
I understand that Big Brothers Big Sisters will run a background check every 3 years while I am matched in the program.

I consent to the preparation and release of background reports to Big Brothers Big Sisters of America and its designated representatives.

Digital Technology & Social Networking

Choosing to participate with your Little in a Social Networking sites requires prior consent from parents/guardians. Additional limitations are as follows:

Under no circumstances are volunteers allowed to place photo or video materials of the match on media that cannot be set to private.
Do not participate in online communication with the Little without parent’s prior consent.
Your social media pages must be set to private so that only people you approve can view your online content and photos. You must have agency approval to post match content.
Never post the names or contact information for your Little, Parents/Guardians or agency staff.
Never post identifying information about your Little or their family, such as home address, school or work.
Never post anything that could be perceived as judgmental or offensive to your Little or their parents/guardians.
Honor confidentiality guidelines within your match.
Be aware of other postings on your page that may be inappropriate for minors. Know that as a BBBS Volunteer you are a role model at all times.
When in doubt about whether or not something is appropriate to post, consult with your BBBS staff.

I have read the above statement and understand Big Brothers Big Sisters of Southwest Washington’s policy regarding Social Networking. I agree that I will fully adhere to the terms of the policy as a condition of my involvement with the agency, and understand that failure to comply with this policy may result in a severance of my relationship with the agency. This statement shall remain in full force and effect for the entire duration of my involvement with Big Brothers Big Sisters of SW Washington and thereafter.

Firearms & Weapons Policy

Volunteers must disclose any firearms and/or weapons ownership both at enrollment and throughout the life of the match. All volunteers owning firearms and/or weapons must sign an attestation that states any weapons, firearms, and/or ammunition are:

Permitted
Licensed
Registered
Handled in accordance with all state and federal laws

VOLUNTEER AGREEMENT
While some adults possess weapons for hunting and/or protection purposes, it is the policy of Big Brothers Big Sisters of Southwest Washington that all agency volunteers agree:

To inform Big Brothers Big Sisters of Southwest Washington of the ownership of weapons or the presence of weapons in the home. Big Brothers Big Sisters staff will discuss the ownership of weapons during the volunteer’s interview and/or home assessment, and update the status for the life of the match. For purposes of this policy, weapons will include firearms, handguns, zip guns, archery equipment, knives (except for kitchen knives or small pocket knives not used or intended for use as a weapon or to inflict bodily injury) and explosive devices.
To ensure that weapons and ammunition are inaccessible to the child assigned to you by Big Brothers Big Sisters of Southwest Washington and to any other child participating in a Big Brothers Big Sisters of Southwest Washington activity, while the child is under your supervision. The means of ensuring the inaccessibility will be discussed during the interview and/or home assessment.
To adhere to the policy that a volunteer will not carry a concealed handgun at any time while accompanying the child assigned to you by Big Brothers Big Sisters of Southwest Washington or any other child participating in a Big Brothers Big Sisters activity (with the exception of law enforcement officers who are required to carry a weapon at all times and have received prior approval from Big Brothers Big Sisters of Southwest Washington).
To understand that Big Brothers Big Sisters of Southwest Washington will disclose to the parent or guardian of the child assigned to you by Big Brothers Big Sisters the Agency’s weapon policy and the volunteer’s admission of weapon ownership of the presence of a weapon in the home. The parent/guardian and the volunteer will sign an acknowledgment of the ownership of a weapon and the form will be kept in the child’s permanent file.
All volunteers agree to abide by any state and federal laws regarding ownership or possession of firearms and/or weapons and ammunition.
All volunteers agree to abide by any other policy or procedure that Big Brothers Big Sisters of Southwest Washington may put into effect regarding weapons.
As a volunteer, I understand and agree to abide by the Firearms and Weapons policy of Big Brothers Big Sisters of Southwest Washington. I agree to keep any weapons inaccessible to the child assigned to me by Big Brothers Big Sisters of Southwest Washington while they are in my custody.
There is a gun/weapon in my household. The name of the gun owner is __________________. There is not currently a gun/weapon in my household. However, for the duration of my match, if there ever is a gun/weapon in my household, I will abide by the gun storage agreement. I will inform agency staff if I or someone I live with acquires a gun throughout any point in my involvement with the agency.
As a volunteer Big, I agree to keep all guns/weapons that may be in my home inaccessible to my Little. I will do this by assuring that the following precautions are taken:
- All guns/weapons in my household will be unloaded, locked-up, and inaccessible to my Little.
- All guns in my household are registered when legally required.
- Any bullets or ammunition in my household will be locked-up separately from the guns/ weapons and will be inaccessible to my Little.
- My Little will have no knowledge of guns/weapons being stored in my home.

There is a gun/weapon present in my household, and I am the ownerThere is a gun/weapon present in my household, and I am NOT the ownerThere is not currently a gun/weapon present in my household. However, for the duration of my match, if this changes, I will abide by the gun storage agreement and inform agency staff.

I realize that if there is a gun/weapon in my household, even if I am not the owner, I am responsible for taking these safety measures throughout the duration of my match. I understand that this agreement may be discussed with the Little’s parent or guardian in the match proposal call, and will be monitored by my Case Manager/Match Support Specialist in follow-up calls.

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