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Volunteer Policy & Profile The Big Brothers/Big Sisters Association of Cincinnati is a social service program designed to help children who have a special need for a strong relationship with an interested adult. Big Brothers/Big Sisters Association of Cincinnati does not discriminate on the grounds of age, race, sexual preference, or religion. While we are an interfaith and an interracial program, we do respect the desires of the child's parent or guardian in selecting the appropriate adult for each child. Careful consideration must be given to many factors, past and present, before determining whether an applicant may be considered for the Big Brother/Big Sister program. Certain aspects of your family life, health, personality and behavior may have a significant impact on the relationship you form with your Little Brother/LittleSister. The questions below are designed to help us evaluate and address any potential issues or concerns before the match is made. Pertinent information will be shared between all parties concerned in order to create the best match, though names will be kept confidential until the match is made. In addition, based on the information you provide, we will conduct a pre-assignment interview to establish a profile on you and your interests to help us find the most suitable match for you. We will generate a similar profile of the child which will be discussed with you to insure that your desires will be respected. *Any party has the right to refuse to enter into the match base upon this information. The undersigned affirms that he/she has read and understands the above statement. The undersigned further acknowledges that he/she is not obligated, if called upon, to perform the volunteer services herein applied for, nor is the Agency obligated to actively seek to assign him/her a Little Brother/Little Sister. The undersigned also understands that additional personal information may be elicited from the applicant by professional Agency personnel. Signed:____________________________________ Date:______________ Print your Name:___________________________ APPLICATION FOR CONSIDERATION AS A BIG BROTHER/BIG SISTER *Please give careful consideration to each question before answering
Name:_________________________________ Social Security #: _____ - _____ - _____ Street Address:____________________________________________________________ City:_________________ State:______ Zip:_________ Phone:( )________________ Birthdate:_____ - _____ - _____ Age:________ Place of Birth:____________________ Email address: _____________________ Race:____________ Religion:_____________ Church/Synagogue:______________________ Occupation:______________________ Place of Business:______________________________ Years employed there? _______ Business Address:________________________ Zip:________ Phone:( )___________ Highest level of education achieved (List names, places, and degrees earned,if applicable): Elementary School:____________________________ Degrees earned:______________ High School:_________________________________ Degrees earned:______________ Trade School:________________________________ Degrees earned:______________ College/University:____________________________ Degrees earned:______________ Family Status (circle one): Single Married Divorced Separated Remarried Widowed Years married:_______ Name of Spouse: (Mr/Ms) _______________________________ Please list names, sex, ages and marital status of children: Name Sex Age MaritalStatus __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Are you currently seeing a doctor for a physical or emotional condition? Yes / No Do you take medication regularly? Yes / No If so, please explain: Have you ever been arrested? Yes / No Please explain: Do you object to the agency checking with the appropriate public authorities for matters of public record regarding your background or history? Yes / No Do you have auto liability insurance? Yes / No Name of Provider:______________________________ Phone:( )_________________ List the name and addresses of three references (other than family) and, if possible, include one clergyman and one supervisor or business associate.
If yes, Name of Agency_____________________________________ Date: __________
Do you have any other experience working with children? Yes / No If so what? ________________________________________________________________ What age groups are you interested in working with?(circle one) 8-10 / 11-13 / 14-17 / Any Have you discussed the possibility of becoming a Volunteer with your spouse? Yes/ No Reaction of Spouse: How do you spend your leisure time? __________________________________________________________________________ Do you have any specials skills or hobbies? __________________________________________________________________________ Do you belong to any Service or Fraternal Groups? __________________________________________________________________________ Do you receive the American Israelite? Yes / No
Circle those physical and or behavioral traits, if exhibited by a child, do you feel you could accept or handle?
Please list any other traits which you might have difficulty dealing with:
Signed:_______________________________________ Date:____ - ____ - ____
BIG BROTHERS/BIG SISTERS ASSOCIATION OF CINCINNATI 513-761-3200 |