Big Brothers Big Sisters matches adult volunteers with children (ages 5-17) for the purpose of developing long-lasting mentoring relationships. The applicant has applied to be a Big Brothers Big Sisters Volunteer and has agreed to make at least a one-year commitment to the program. Volunteers spend 4-8 hours per month on average with their Littles.
This is a standard reference questionnaire and similar questions are asked of the applicant during their interview. All information shared in this reference will remain confidential.
Once you have completed the form, click the “Submit” button. You will see a message confirming that your form has been successfully submitted.

Your Name*

First

Last

Applicant's Name*

First

Last

How long have you known the applicant?*In what way do you know the applicant?*How well do you know the applicant?*Very wellWellAverageNot wellDescribe how the applicant relates to people and forms relationships?*Please write here about their relationships with you, friends, family and/or co-workersHave you seen the applicant around children? What were your impressions or feelings about that interaction; if you have not seen them around children, what qualities do they have that would be applicable to working with children?*Please comment on applicant's ability to relate to authority or follow rules.*To the best of your knowledge has the applicant ever sought or are they currently seeking any form of professional counseling or therapy?*YesNoIf yes, please explainDo you think this is an appropriate volunteer opportunity for the applicant based on their experience and/or time availability?*YesNoPlease explainTo the best of your knowledge, has the applicant ever been arrested?*YesNoPlease explainTo the best of your knowledge, has the applicant ever experienced drug or alcohol related problems?*YesNoIf yes, please explainTo the best of your knowledge, has the applicant ever been involved in child molestation or a sexual relationship with a minor?*YesNoIf yes, please explainWould you feel comfortable leaving a child alone with the applicant or letting the applicant drive a child?*YesNoIf no, please explainHave you had the opportunity to see the applicant's current home environment?*YesNoPlease describe the applicant's current home environment and neighborhood*What are some things a child might do there?*Do you have any concerns about a child's safety in this applicant's home environment?*YesNoPlease explain*Who lives with the applicant?*Are there any weapons stored in the home?*YesNoI don’t knowIs there anything else you would like to share about this applicant?Please provide a phone number so that we can contact you if additional information is needed*What is the best time of day to reach you at this number?*Your email address*

Please check the box to agree*

The information I have given is truthful to the best of my knowledge.
Signature*please type your full nameWould you like more information about how to become involved as a volunteer or supporter of Big Brothers Big Sisters?*YesNoPlease contact me with more information about the following:I want more information about being a Big.I want to help with fundraising.I want to help with volunteer recruitment efforts.Please check all that apply.

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