Home
Volunteer
Enroll a child
For our Bigs
Match Highlights
The whiteboard project
Donate
Partners
About
Mentoring Works
Contact
Alumni
*
Indicates required field
Name
*
Main Phone Number
*
Choose One
*
Cell
Home
Work
Gender Identity
*
Female
Male
Non-Binary
Other
Date of Birth
*
Email
*
Local Address
*
Line 1
Line 2
City
State
Zip Code
Country
Permanent Home Address (if student)
*
Line 1
Line 2
City
State
Zip Code
Country
How did you hear about us?
*
Friend or family member
A college club
A special event
Internet search
Always known
Do you have a car
*
Yes
No
Reliable access
How long are you going to be in Ithaca?
*
What is your expected graduation year? (If student)
*
Big Brothers Big Sisters, and the Ithaca Youth Bureau, value and celebrate all people. We accept and support volunteers regardless of race, ethnicity, ability, gender, gender expression, sexual orientation, religion, or any other aspect of a person's diverse background. With this in mind, we make matches partially based on the preferences of families, even when their views and values may differ from those of our agency.
The following information will help us ensure that our volunteers and families are comfortable and safe in a long lasting match. Any answers you provide will be confidential and only seen by BBBS staff for matching decisions.
You are not required to answer these questions in order to participate in our program.
Race/Ethnicity:
*
Do you belong to any religion? If so, what?
*
List any languages other than English that you speak:
*
Occupation:
*
Do you currently think of yourself as (check all that apply):
*
Straight
Gay or lesbian
Bisexual
Do you currently think of yourself as (check all that apply):
*
Male
Female
Transgender
Non-binary or gender non-conforming
Please let us know the affirming pronouns by which we should address you:
*
For your own safety, do you have any medical condition that we should be aware of? If yes, please explain:
*
REFERENCE INFORMATION:
Reference 1
A family member, spouse or spousal equivalent:
Name
*
Email
*
Phone Number
*
Relationship
*
Reference 2
Someone who knows you through work or school:
Name
*
Email
*
Phone Number
*
Relationship
*
REFERENCE 3
A personal reference, such as friend:
Name
*
Phone Number
*
Email
*
Relationship
*
Reference 4
If you have volunteer or paid work experience with kids, please enter it here:
Name of organization
*
Phone Number
*
Contact person
*
Email
*
I understand that:
The references I listed may be contacted by mail, telephone, or email.
The BBBS agency is not obligated to match me in the program.
As part of our enrollment processes, I may be asked to provide additional personal information prior to making any recommendations for matching.
The time commitment is 4-8 hours a month for one full year from the time I am matched.
I will need to attend a pre-match training before I am matched.
I will be required to check in monthly with my Match Support Specialist.
Name (electronic Signature)
*
Date
*
Submit
Home
Volunteer
Enroll a child
For our Bigs
Match Highlights
The whiteboard project
Donate
Partners
About
Mentoring Works
Contact
Alumni
