Youth Inquiry Form

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

Gender	Personal Pronouns
How does the youth identify?	What pronouns does the youth use?
School	Graduation Year from High School This is the year the youth will graduate.

School Account ID

Race/Ethnicity

Guardian's Relationship to Youth

The parent/guardian is this child's

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Mobile Phone

Personal Email

I prefer to be contacted by

Family Information

Which community are you enrolling your youth in?

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

County:

My child can make a one year commitment to participating in this program.

As the child's parent/guardian, I am willing and able to participate in monthly conversations with a Big Brothers Big Sisters Mentoring Relationship Specialist to discuss how the match is going.

I understand that to be eligible for participation, both my child and I must participate in mandatory intake interviews with a Big Brothers Big Sisters team member. I understand the meeting(s) will be booked at a time of my choosing. The parent portion of the interview takes approximately one hour. The child portion of the interview also takes approximately one hour.

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

Contact Information