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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

*At Big Brothers Big Sisters of Utah we enroll kids between the ages of 6 and 17. If your youth falls outside of this age range, they are not currently eligible to be enrolled in our program.*

Youth First Name

Youth Last Name

Application Name

Preferred Name

Birthdate (mm/dd/yyyy)

Gender

High School Graduation Year

Race/Ethnicity: (press and hold "CTRL" button for multiple selections)

Nationality/Country of Origin: (press and hold "CTRL" button for multiple selections)

How does the youth identify?

Other Race/Ethnicity

Other Nationality/Country of Origin

Parent/Guardian Information

*If you are referring a child for our program, please enter their parent/guardian's information below and add your contact information/any pertinent details in the accommodation section below (please ensure that you have spoken with the parent/guardian about the program as well)*

Guardian First Name

Guardian Last Name

Mobile Phone

Personal Email

Contact Preference

Relationship to Youth

Family Information

Which community are you enrolling your youth in?

Agency Location ID

Street Address

City

State

Zip Code

Guardian Employment

Employer

Employer Street Address

Employer City

Employer State

Employer Zip Code

Accommodations

Do you require any special accommodations when completing this application? (i.e., referring a child for the program that you do not have custody of, translation services, assistance when filling out, etc.)

Please explain what accommodations you require

Clicking Submit below indicates that you are interested in enrolling a child or children as a Little in our program. Please be aware that this is not an application. You will will be redirected to the application page after you click submit.

If you are receiving an error message and unable to submit this form, email or text Carl Grimm for help (801-970-2952, carl.grimm@bbbsu.org).

Contact Information