Child Application

Once we receive your submission we will follow back up with you on next steps.

If you have any questions in the meantime please email us at info@bigmentor.org or call (210) 225-6322.

Child Application

By completing the enrollment form below your child(ren) will begin the process to be matched in the Big Brothers Big Sisters program.

Parent/Guardian First Name(Required)

Parent/Guardian Middle Name

Parent/Guardian Last Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Primary Email Address(Required)

Secondary Email Address

Home Phone

Cell Phone(Required)

Preferred Contact Method

Phone

Text

Parent/Guardian Workplace

Work Phone

May we contact you at work?

Yes

Parent/Guardian's Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Parent/Guardian's Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Parent/Guardian's Highest Level of Education

Parent/Guardian's Date of Birth

Child Information

Child's First Name(Required)

Child's Middle Name

Child's Last Name(Required)

Child's Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Child's Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Child's Gender

Male

Female

Transgender: Male to Female

Transgender: Female to Male

Non-binary

Child's Birth Date(Required)

Child's School

Child's Grade

Child's Student ID #

Child's Cell Phone

Child's Email

Child's Social Security Number

Child's First Name(Required)

Child's Middle Name

Child's Last Name(Required)

Child's Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Child's Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Child's Gender

Male

Female

Transgender: Male to Female

Transgender: Female to Male

Non-binary

Child's Birth Date(Required)

Child's School

Child's Grade

Child's Student ID #

Child's Cell Phone

Child's Email

Child's Social Security Number

Child's First Name(Required)

Child's Middle Name

Child's Last Name(Required)

Child's Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Child's Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Child's Gender

Male

Female

Transgender: Male to Female

Transgender: Female to Male

Non-binary

Child's Birth Date(Required)

Child's School

Child's Grade

Child's Student ID #

Child's Cell Phone

Child's Email

Child's Social Security Number

Child's First Name(Required)

Child's Middle Name

Child's Last Name(Required)

Child's Race

American Indian

Alaskan Native

Asian

Black/African American

Native Hawaiian/Pacific Islander

White/Caucasian

Some Other Race

Child's Ethnicity

Hispanic/Latino

Not Hispanic/Latino

Child's Gender

Male

Female

Transgender: Male to Female

Transgender: Female to Male

Non-binary

Child's Birth Date(Required)

Child's School

Child's Grade

Child's Student ID #

Child's Cell Phone

Child's Email

Child's Social Security Number

Living Situation

Family Income Range

Do you receive any Income Assistance?

Yes

Food Stamps?

Yes

Free/Reduced Lunch?

Yes

Are any of your children currently on probation?

Yes

If yes, enter child's name(s) here

Child's Probation Officer name and unit, if applicable

Reason for referral to Juvenile Probation

Does your child have a family member (parent, sibling, grandparent, etc.) who is/was incarcerated, on probation, or parole?

Yes

Incarceration Status

Current

Incarceration Type

Incarcerated

Probation

Parole

If yes, how is this person related to your child?

Does any parent/guardian of any of these children have current or prior military involvement?

Yes

Military Status

Branch of Service

How did you hear about the program?

Have you ever been involved with BBBS before?

Yes

If yes, how?

Referral Type(Required)

Media Source(Required)

Social Media Source(Required)

Website(Required)

www.bigmentor.org

www.bbbs.org

www.mentoring.org

www.sa2020.org

www.volunteermatch.org

Other

Relationship Type(Required)

Event Name(Required)

Mixer Name(Required)

Black History Month

National Mentoring Month

Volunteer Appreciation

Other

Faith Based Source(Required)

Church

Other

Legal Source(Required)

Child Protective Services

Court

Legal Nonprofit

Probation

School Type(Required)

College/University

Fraternity/Sorority

Other

Employer Name(Required)

Social Services Source(Required)

Counselor

Dr/Medical Provider

Good Samaritan

Other Nonprofit

Therapist

Campaign/Event Name(Required)

MENtoring Movement

Operation: Big Mentor

Partner Name(Required)

Referral Details

What is your primary reason for applying to this program?

Please click and sign below to authorize the following Releases/Permissions:

SURVEYS(Required)

Surveys may be administered to my child(ren) to assess his/her progress in the program.

Yes

SCHOOL RECORDS(Required)

Big Brothers Big Sisters may have access to my child(ren)'s school records.

Yes

MEDIA RELEASE(Required)

May we share images of your child experiencing our program to help us recruit more mentors?

Yes

Parent Initials(Required)

Confirm media release by inputting your initials.

By typing your name in the box below you are signing this application electronically and agreeing to all the boxes checked above.(Required)

Date

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