• Serving Antrim, Charlevoix, Emmet, Grand Traverse and Kalkaska Counties

Statement of Understanding

I understand that by submitting this application I am not obligated, if called upon, to perform the services applied for. Personal information provided here is accurate. The agency is not obligated to match me with a child and can at anytime terminate my application or mentoring relationship. All information gathered is the property of Big Brothers Big Sisters of Northwestern Michigan (Bigs) and only available for review by the Bigs’ team. If I am accepted as a Big, I understand my obligation to meet with my Little regularly and as required, inform the Bigs’ team of the status of my match relationship. I further agree to accept the supervision of the Bigs’ team and discontinue my service if I am requested to do so.
Social Security Number (Required for Background Checks) Bigs conducts layered background checks as a critical component of the enrollment process to ensure child safety. Checks completed may include: local & county police records, state police records, national background search, driving record, the National Sex Offender Registry, local public court records (where available), and the Department of Health and Human Services Abuse/Neglect Central Registry. A completed and signed consent form is required to be considered for participation and can be found at the bottom of this application.
Please list any arrests, convictions, and traffic violations you have incurred. Felony or misdemeanor offenses for a sex-related crime or violence against a person automatically disqualifies an applicant from participation in the program.
If not applicable, please note “N/A” above.

Driver Information

Emergency Contact Info

References

References are an important part of the application process. We ask for references from specific people who have known you for a period time. Please let the individuals know that they will be hearing from us via text and/or email as part of your screening for the Bigs program. By initialing above and submitting your application, you authorize the below listed references to disclose information to Bigs regarding your character and/or any past youth-serving experience.

Reference 1

Parent or Legal Guardian

Reference 2

Teacher/School Counselor

Reference 3 (If Applicable)

Volunteer or paid experience working with children (If you have had any volunteer or paid experience working with youth, you must list the organization(s) and/or individual(s) as a reference. Examples include camp counselor, mission trips or coaching youth. Babysitting does not qualify) Required information: Name of organization, Name of Contact Person, Phone Number, Email and Dates of Involvement.

Parent/Guardian Permission for Teen Volunteer Participation in School-Based Mentoring Program

As a Big in the BBBS School-Based mentoring program, I understand my teen will be expected to adhere to the following rules:
1.) The match with an elementary school student (the Little) is for a minimum of one school year.
2.) All activities between my teen and the Little will take place on school property at a time approved by school personnel that does not remove my child from an academic class.
3.) My teen is not allowed to transport a Little under any circumstances or arrange to see them outside of the school setting.
4.) My child will contact their BBBS Mentoring Specialist immediately if there are any questions or concerns.
5.) I will support my teen’s participation in the BBBS program so that it will be a positive and beneficial experience for both the Big and the Little with whom they are matched.
Do you consent to the above for your teen?
I give permission for my child to participate in publicity events, such as radio, television, social media, printed material and news articles regarding the Bigs’ program while they are a Big.

Background Consent Form

Please print the Background Check Consent Form, hand sign and return via email to brooke.stebner@bigsupnnorth.com or by mail to:
 
Big Brothers Big Sisters
c/o Brooke Stebner
900 E. Front Street, Suite 125
Traverse City, MI 49686
I have printed, completed and submitted the Background Consent Form.
Click or drag a file to this area to upload.
Upload a fully completed and signed consent form here.

Questions

If you have any questions, please contact Brooke Stebner at brooke.stebner@bigsupnorth.com or call/text 231.620.3193.