How do you prefer to be contacted?
Are you a student at this time?
Do you have current or past military experience?
Are you separated/discharged (other than retired)?
If retired, separated, or discharged, please check the character of separation/discharge:
Do you have a current and valid driver’s license?
Do you have valid insurance that meets or exceeds state required minimum?
Have you previously applied to be or served as a mentor or Big Brother or Big Sister here or anywhere else?
Have you ever been involved with Champions of Youth or Big Brothers Big Sisters in a capacity other than a Big?
Have you ever been involved with or volunteered for another youth organization?
Have you ever been denied acceptance or released from service as a volunteer or employee by Champions of Youth, a Big Brothers Big Sisters program, or another youth-serving organization?
Are you interested in learning about additional ways to contribute to mission of Champions of Youth?
If yes, please check all interests that apply.
Please list information for at least three references below including:
- Your spouse or domestic partner (i.e., if you live with a significant other/ girlfriend/boyfriend) OR a family member, if you do not have a spouse, partner, or significant other);
- Current or former employer or co-worker you have known for at least one year, or someone from your school if you are a student; AND
- A friend or neighbor you have known for at least two years.
In addition to the references above, Big Brothers Big Sisters requires references from all youth serving organizations at which you have worked or volunteered in the past. Please list additional on separate page, if needed.
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 Champions of Youth 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, Champions of Youth is not required to disclose reasons for doing so;
- 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 and a home assessment;
- 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 (e. address, phone number, auto-insurance, new criminal charges, etc.).
- I agree to timely communication and follow-up with all agency staff.
Please read the following carefully before signing this application:
I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Champions of Youth.
I certify that all information I have provided or will provide to Champions of Youth, including this application, is true, correct and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained on my application will be verified by Champions of Youth. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.
At any time while involved with the Champions of Youth program, I agree to immediately inform my Champions of Youth contact person of any and all infractions, violations, charges and convictions related to any civil, domestic, or criminal occurrences. I understand that Champions of Youth staff needs to be fully informed to provide the best guidance or support possible.
Other Adult Resident(s) in Volunteer Applicant’s Home:
As an adult resident of the same home as the volunteer applicant, the information he/she has provided may be used to conduct a background check on me, to include a search of public domain records, driving records check, juvenile and adult criminal history check, military records, and other records where required by local, state, or federal law.