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.
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.
Emergency Contact Info
Parent or Legal Guardian
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
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.
Upload a fully completed and signed consent form here.