Big Brothers Big Sisters of Sangamon County

 

Big Brothers Big Sisters of the Illinois Capital Region
Volunteer Application

Please indicate which volunteer position you are interested in:
Community Based Mentoring Options:
Big Brother Big Sister Couple Match Waiting List Volunteer
Site Based Mentoring Options:
Corporate Mentoring High School Mentoring

Please note that if you are applying for a couple match, each person must fill out a separate application.
NAME: ETHNICITY:
African-American Asian
Caucasian Multi-Racial
Hispanic/Latino Other
HOME ADDRESS: OCCUPATION:
CITY: EMPLOYER OR SCHOOL:
ZIP: BUSINESS ADDRESS/PHONE:
HOME PHONE: CELL PHONE:
EMAIL: WORKING HOURS:
DATE OF BIRTH: (High School Volunteers Only)
NAME OF HIGH SCHOOL:
EDUCATION LEVEL COMPLETED: MAY WE CALL YOU AT WORK?
YES   NO
GENDER: MARITAL STATUS:
MALE   FEMALE
SINGLE MARRIED  
SEPARATED DIVORCED WIDOWED
DO YOU HAVE ACCESS TO AN AUTOMOBILE? IF PRESENTLY MARRIED, SPOUSES FULL NAME:
YES   NO

Please list at least four references both personal and professional:
  • References must have known you for at least one year.
  • One reference must be a family member or spouse/significant other. One reference must be an employer or school reference. One reference must be a co-worker, friend or neighbor.
  • Please note that couple matches must provide two references for individuals that know them as a couple.
  • HIGH SCHOOL VOLUNTEERS – AT LEAST ONE OF YOUR REFERENCES MUST BE FROM A TEACHER
Name and Relationship Daytime Phone
Reference #1:  
Reference #2:  
Reference #3:  
Reference #4:  

HAVE YOU EVER BEEN INVOLVED WITH BIG BROTHERS BIG SISTERS IN ANY CAPACITY?
YES   NO
IF SO, WHERE AND WHEN?
WHAT, IF ANY, OTHER YOUTH ORGANIZATIONS HAVE YOU WORKED FOR OR BEEN INVOLVED WITH AS A VOLUNTEER?

STATEMENT OF UNDERSTANDING
I acknowledge and agree that the Agency is not obligated to assign, or actively seek to assign me a Little Brother or Sister. I certify that all information is true and accurate to the best of my knowledge. I understand that additional information will be solicited by BBBS of the Illinois Capital Region, as part of the routine volunteer intake process and that all information will be kept confidential. If I am accepted as a Big Brother/Big Sister, I understand my obligation to abide by all agency rules and guidelines, including meeting regularly with my Little Brother/Little Sister and maintaining contact with my assigned case manager. 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.

 

Once you have completed this form, click on the submit button. You will sign and date the form at the time of your interview.

Please have a copy of your driver’s license and proof of insurance at the time of your interview.

 

 

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Signature Date

 

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Parent Signature (if under 18) Date

 

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