Volunteering

General Information

Required fields in bold, complete E-Mail OR Phone Number

First Name:
Last Name:
Birthday:      / / (MM/DD/YYYY)
Gender:           Male Female
Driver's License #:
E-Mail:

Phone:
Address:
City:
State:
Zip Code:

References

Please list at least four persons who can vouch for your reputation, character, and morals. Please do not use relatives, spouse, or significant other.

They MUST have known you for at least one year.
One reference MUST be a work or school reference
One reference should be familiar with your home enviroment
All information will be treated confidentially and will not be shared.

Reference One Name:
Address:
City:
State:
Zip Code:
Phone:
E-Mail:

Reference Two Name:
Address:
City:
State:
Zip Code:
Phone:
E-Mail:

Reference Three Name:
Address:
City:
State:
Zip Code:
Phone:
E-Mail:

Reference Four Name:
Address:
City:
State:
Zip Code:
Phone:
E-Mail:

Legal Record Arrest/Violation Date: / / (MM/DD/YYYY)
Charge:
Disposition/Result:

Arrest/Violation Date: / / (MM/DD/YYYY)
Charge:
Disposition/Result:

Statement of Understanding

If I am accepted as a Big Brother/Big Sister, I understand my obligation to meet with my Little Brother/Sister regularly and to inform BBBS agency staff as to the status of my match relationship every month. I further agree to accept the supervision of the BBBS staff and discontinue my service if I am requested to do so by the agency.

I Agree