BigApp

Big Application

Welcome to Big Brothers Big Sisters! Becoming a Big is a powerful, life-changing volunteer experience. You will gain friendship and community. You will also experience consistent support, connection, and joy.

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability.

Hidden Fields

Contact ID 18 Character

Enrollment ID 18 Character

Contact Owner ID

Contact Owner Email

Program Information

Program

Program ID

Basic Information

First Name

Middle Name

Last Name

Maiden/Alias

input NA if none

Preferred Name

Birthdate

Social Security Number

Gender

How do you identify?

Personal Pronouns

What pronouns do you use?

Race/Ethnicity

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

Tribal & Regional Corporation Affiliations

Nationality

To select multiple, hold CTRL/CMD and click.

Relationship Status

Do you have a driver's license?

Driver's License Number

Driver's License State

Driver's License Expiry

Please upload a copy of your license

File can be a screenshot, PDF, or picture

Auto Insurance Effective Date

Auto Insurance Company

Please upload a copy of your auto insurance.

File can be a screenshot, PDF, or picture

Contact Information

Personal Email

Work Email

Alternate Email

Preferred Email

Mobile Phone

Work Phone

Work Phone Extension

Home Phone

Alternate Phone

Preferred Phone

Best Time to Call

In general, do you prefer to be contacted by email or phone?

Mailing Address

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

Mailing address is different from residential address

Physical Address

Street Address

City

State

Zip Code

Emergency Contact Information

Name

Phone

Relationship

School

Graduation Year

School Account ID

Education

Level of Education

Year Degree Obtained

Education Years Completed

Employer Information

Employment Status

Name of Employer

Occupation

Employment Length (Months)

Employment Length (Years)

Employer Address Line 1

Address Line 2

City

State

Postal Code

Is it okay to call at work?

YesNo

Additional Information

Agency Location ID

NOTE for BBBS staff (delete before making the form live): You will need to update the drop down above with the corresponding options for your chapter. Then click on the blue Options button for the dropdown, go to the Calculations section, and input the corresponding Agency Location IDs into the boxes.

Have you served in the military?

How would you describe yourself, in terms of participation in events, activities, or sports?

Which activities do you enjoy more?

How did you hear about Big Brothers Big Sisters?

Referral Detail ID

References

Previous Experience

Have you previously applied to be or served as a Big here or anywhere else?

YesNo

When?

Where?

Have you ever been involved with Big Brothers Big Sisters in a capacity other than a Big?

YesNo

When?

Where?

Have you ever been denied acceptance or released from service as a volunteer or employee or another Big Brothers Big Sisters Program for another youth-serving organization?

YesNo

When?

Where?

Have you ever actively volunteered or worked with youth before as a Big or otherwise?

Youth Serving Work or Volunteer Experience

YSO Reference ID

Organization Name

Location

Start Date

End Date

Direct Supervisor First Name

Direct Supervisor Last Name

Phone

Email

Years Known

Reason for Leaving

Please provide at least three references below including:

Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other
School personnel, current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
A friend or neighbor you have known for at least two years
If you have adult children, they must also be listed as a reference

Spousal/Familial Reference

Spousal/Familial Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Adult Child Reference

Spousal/Familial Reference ID

Do you have adult children?

First Name

Last Name

Email

Phone

How did this child join your family?

Year of Adult Child's Birth

Professional Reference

Professional Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 1 year

Personal Reference

Personal Reference ID

First Name

Last Name

Email

Phone

Relationship to you

Years Known

Minimum 2 years

I consent to and understand that:

The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
I am in no way obligated to perform any volunteer services;
The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so;
Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.
I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);
It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.)
I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
I agree to timely communication and follow-up with all agency staff as required by the agency.

I accept the terms and conditions

Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.

Do you have any concerns about your ability to fulfill the Big Brothers Big Sisters of Central Nebraska commitment required of mentors?

YesNo

Do you anticipate any significant life changes over the next year or have you had any this past year? (ie. job or schedule changes, moving, new family member, etc.)

YesNo

Please describe:

Have you ever been accused, arrested, charged, or convicted of a crime?

YesNo

Please describe:

Have you had any driving citations and/or moving violations in the past five years?

YesNo

Please describe:

Do you have guns, ammunition, or other weapons in your house?

No GunsGuns Secured

Agency Weapons Policy

A Volunteer who owns firearms and stores them at his/her residence or any other location will lock the weapons or install trigger locks whenever a Little is at or near the storage area.

Volunteers must also abide by the following:

Possession of firearms is to be disclosed to BBBS’s Agency Staff at enrollment and throughout the life of the match.
Possession of firearms and permit to conceal and carry is disclosed to the child’s parent/guardian by Agency Staff.
Volunteers must attest to the fact that any weapons, firearms or ammunition ownership are licensed, permitted, registered, and handled in accordance with all applicable city, state, and federal laws.
Agency Staff must obtain a copy of the Volunteer Big’s conceal and carry permit and place it in the Volunteer Big’s permanent file.

Guidelines which will be reviewed with and agreed to by the Volunteer Big and parent/guardian, and documented in the match file covering, at a minimum:

Weapons, firearms and ammunition will be made inaccessible at all times to a child while in the Volunteer Big’s care, unless participating in specific, approved activity(ies), which the parent/guardian, Volunteer Big, MSS, and Supervisor have approved in advance and such approval is documented in the match file (e.g., hunter safety courses).
Ammunition will also be stored separately and inaccessible to the Little.
If firearms are used for any activity: the Little shall have completed a gun safety course or equivalent and provide documentation to BBBS.
The firearm will be transported to and from any activity in compliance with state and federal laws in a manner in which the Little cannot gain access to the firearm.
Volunteers will closely supervise their Little at any time the Little is handling a firearm.
Both the Volunteer and Little will observe all safety precautions during the activity.
Volunteers will sign a separate acknowledgement of BBBGI’s firearms and weapons guidelines.

I agree to keep any weapons and ammunition inaccessible to the child assigned to me by BBBS while he/she is in my custody, unless on a specifically approved match activity, as described above.

What languages do you speak fluently? (select all that apply)

African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
English	French
German	Greek
Hebrew	Hmong
Indian (Hindi, Punjabi)	Italian
Japanese	Keres (West)
Korean	Lao
Nordic	Persian
Portuguese	Russian
Spanish	Turkish

Please list any counties and states that you have lived in aside from your current address in the past five years.

City/State

From

Please provide the name, age, and relationship to you for anyone else residing in your home.

Name

Birth Date

Confidentiality Agreement

In order for Big Brothers Big Sisters of Central Nebraska to provide a responsible and professional service to clients, it is necessary for Volunteers, Clients, and/or Parents or Guardians of clients to be asked to divulge extensive personal information about themselves and their families. The agency respects the confidentiality of the Client and Volunteer records (whether it be verbal, written, or otherwise documented) and, with the exception of situations below, share information about Clients and Volunteers only among the agency professional staff. The right to confidentiality applies not only to written records, by also to video, film, pictures, or use of client’s or volunteer’s name in agency publications.

All records are consider the property of the agency and not the agency workers, Board of Directors members, clients or volunteers themselves. In order to provide a service, which is in the best interest of the program, information from outside sources, including confidential references, must be asked along with information gained from the clients and volunteers themselves. Records are not available for review by the clients or volunteers. Clients and volunteers must be provided at the time of application this statement on confidentiality along with the exceptions, which define the limits of confidentiality. Agency staff, designated board members, clients, and volunteers shall sign a statement that he/she has read and understands the Big Brothers Big Sisters policy on confidentiality and agrees to program participation under the guidelines that it sets forth.

Limits of Confidentiality

Information will be released to other individuals or organizations only upon an authorized form appropriately signed by the client or volunteer.
Identifying information regarding clients or volunteers may be used in agency publications or promotional materials if the client or volunteer has given permission.
For purposes of program evaluation, audit, or accreditation, and with prior approval from Board of Directors, certain outside bodies may have access to client and volunteer records. These outside organizations shall be required to respect the agency policy on confidentiality. Outside parties shall be required to use the information only for the purpose(s) stated in the approval action of the Board of Directors. Known violations of agency policy will be reported to the supervisor of the individual involved and appropriate disciplinary action shall be requested.
Members of the Board of Directors have access to client files only upon authorization by formal motion of the Board of Directors. The motion shall state who will be authorized to review records, the specific purpose for such review, and the period of time during which access shall be granted. Members shall be required to comply with the agency policies on confidentiality and may use the information only for the purposes state by the approved action of the Board of Directors. Known violations shall be reported to the Board President. A violation of the agency’s confidentiality policy by a Board Member shall constitute for adequate removal from office.
Information shall only be provided to law enforcement officials or the court system pursuant to a valid and enforceable subpoena.
Information shall be provided to an agency’s legal counsel in the event of litigation or potential litigation involving the agency. The information is considered privileged such confidentiality is protected by law.
State law mandates suspected child abuse be reported to the appropriate authorities. All workers responsible for staying abreast of such reporting requirements of their respective jurisdiction and shall always come with mandated procedures.
Should an agency worker receive information indicating that a client or volunteer may be a danger to himself/herself or others, steps may be taken to protect the appropriate party. This may include a medical referral or a report to local law enforcement authorities.
Any party involved in a match (agency staff, parent/guardian, client, or volunteer) may have limited access to information regarding one of the other parties in order to facilitate a “pre-match” introduction. All information that is shared at this time, whether the match is actual or potential, shall be kept confidential by all parties involved.

I have read and understand the information above, which states the agency policy with respect to confidentiality of client and volunteer records on the part of the agency, client, parent/guardian, and volunteer. I agree to program participation under the conditions set forth.

Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).

In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party. I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials. BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

I have read this Consent and Release Form completely. I fully understand what it means, and I agree to its terms. I have not been offered any additional consideration or enticement, nor have I been coerced to sign this document. I am voluntarily signing it for the purposes and considerations described.

Digital Technology and Social Networking Policies

Social Media Usage

Big Brothers Big Sisters of Central Nebraska recognizes that online social networking (Facebook, Twitter, Instagram, LinkedIn, Blogs, etc.) has become a very popular communications tool and that many of our Bigs, Littles, their parent/guardians and agency staff utilize. However, we do not allow matches to connect via social media for the first 12 months of the match in order to focus on building a strong, healthy relationship. After their first anniversary matches are allowed to connect on social media. Volunteers and parents/guardians are permitted to connect via social media at any time if both parties agree.

If a Volunteer chooses to participate in any online communication, the following guidelines should be followed to ensure confidentiality, privacy and child safety:

Volunteer Bigs do not participate in any online communication with/about their Little or post a picture unless they have discussed this with the parent/guardian and have received approval.
If a Volunteer Big chooses to actively communicate with their Little and/or the Little’s parent/guardian via social networking, the MSS will be notified and given the website address and/or username. BBBS is active on Facebook, Instagram, Twitter and LinkedIn.
Volunteer Bigs are never to post the last name of their Little, their parent/guardian or BBBS staff.
Volunteer Bigs are never to post any contact information for their Little.
Volunteer Bigs are never to post any identifying information about their Little (i.e.: child’s home address, school the child attends, where the parent works, etc.)
Volunteer Bigs are never to post anything that could be perceived as judgmental or offensive to their Little, their parent/guardian or BBBS.
If a Volunteer Big is a friend of their Little and/or their parent/guardian, they are to make sure that their page settings are set to private, so that only people the Volunteer Big approves can view the online content.
Volunteer Bigs are to honor confidentiality guidelines within their match; be cautious when posting detailed information about conversations with their Little, their parent/guardian or BBBS staff. Posting generalized information or status updates is typically appropriate, but lengthier postings or blogs containing in-depth information should be approved by the parent/guardian and by BBS prior to posting.
The Volunteer Big will not post information that can only be accessed through participation in BBBS as a Volunteer or a parent/guardian. This includes information that is specific to Bigs and Littles only.
If a Volunteer Big is a friend of their Little and/or their parent/guardian, they need to be aware of other postings on their page that are not BBBS related or are inappropriate for minors. A BBBS Volunteer Big is a role model at all times. A Volunteer Big will ensure that all content are appropriate and youth-friendly, in case their Little and/or their family were to reach their social networking page(s).
A Volunteer Big can choose to create separate permissions for their Little, their parent/guardian and BBBS Agency Staff that limits the Little’s access to general or universal postings.
Should a Volunteer Big have questions or concerns regarding whether a posting is appropriate, the Volunteer Big should consult with the MSS prior to posting.
Volunteer Bigs are essential to the success of BBBS and can share Agency posts/tweets on their page while still honoring the above guidelines.

Failure to adhere to these guidelines may result in the termination of the match.

Cellular Phone Usage

Big Brothers Big Sisters of Central Nebraska expects that each match meeting be important, relationship focused, and impactful for both the Big and Little. BBBS restricts the use of cellular phones. Cell phones should be utilized on a limited basis while the match is meeting.

Examples of appropriate cell phone usage are as follows:

Emergency situations
Communication between a parent/guardian and a Big/Little
Communication with BBBS Agency Staff

Examples of inappropriate cell phone usage are as follows:

Communicating with friends
Social networking
Texting
Working

Failure to adhere to these guidelines may result in the termination of the match.

I have read and understand the above information provided to me regarding Big Brothers Big Sisters' digital technology and social networking policy. I agree by the conditions set forth.

Virtual Platform

Big Brothers Big Sisters of America has developed a digital platform to help Bigs and Littles stay in touch more easily in a safe and secure way. Participation requires your permission.

I consent, should I be matched, to having contact with my Little through Big Brothers Big Sisters' digital platform.

Publicity and promotional materials for Big Brothers Big Sisters are conducted in a variety of forms. May we use your name, image, likeness, appearance, or basic biographical information in these materials?

Substance Use Policy

Volunteer Bigs are prohibited from being under the influence or using any substance (including alcohol, illicit drugs, and legal drugs, including medical marijuana, “legalized” marijuana, and prescription medications) that could potentially affect judgment driving, reaction time, or otherwise jeopardize a child’s safety and wellbeing, while their Little is in the Volunteer Big’s care or company.

I have reviewed the substance use policy and commit to adhering to the policy.

Policy on Mandatory Reporting of Child Abuse and Neglect

The State of Nebraska is a Mandatory Reporting State. The law requires any person who suspects or witnesses child abuse or neglect to report the suspected abuse or neglect to the Department of Health and Human Services Child Abuse Hotline at 1.800.652.1999.

Any Volunteer Big or staff person who has suspicion that a child is being abused (whether the child is a client of the agency or not) is required to report to the Department of Health and Human Services Child Abuse Hotline, as well as to BBBS Executive Director. The same reporting is also required with suspected child sexual exploitation (child pornography or enticement on the internet). Reporting is required by law as well as by agency policy.

BBBS staff will document report(s) in Matchforce and complete an Incident Report and submit it to the Executive Director for review. The ED will maintain a copy.

Any incident or allegation of child abuse or exploitation involving a current or former non-matching volunteer, a current or former Volunteer Big, a current of former Board member, or a current or former Agency Staff associated with BBBS, will be reported immediately to Big Brothers Big Sisters of America and to law enforcement or child protection authorities, in accordance with state and federal law.

Mandatory critical incident reporting to BBBSA includes information obtained from third parties or anonymous sources. Required reports include the following, at a minimum: sexual misconduct against a child or in the presence of a child that may include contact or non-contact behaviors of a criminal nature; physical violence against a child or in the presence of a child; behavior that causes significant emotional or psychological harm to a child, neglect of a child, and any other incident the agency deems critical.

Volunteer Bigs who suspect abuse are to report this to their BBBS Match Support Specialist and follow their professional advice.

I have read this Policy on Mandatory Reporting of Child Abuse and Neglect completely. I fully understand what it means, and I agree to its terms. I have not been offered any additional consideration or enticement, nor have I been coerced to sign this document. I am voluntarily signing it for the purposes and considerations described.

Child Safety Guidelines and Ground Rules for Volunteers

The Little’s safety and well-being is the number one priority. Everyone associated with Big Brothers Big Sisters of Central Nebraska plays a role in helping keep Littles safe.

The following guidelines are established for your match relationship to help you develop a healthy relationship with your Little. The guidelines will also help your Little understand appropriate boundaries and build personal safety skills while allowing them to recognize and trust the caring adults in their lives.

I will maintain confidentiality regarding the information I learn about my Little and their family, which I may only share with Big Brothers Big Sisters staff and/or parents, or law enforcement, if necessary.
If I suspect abuse or neglect of my Little, I will notify Child Protective Services and law enforcement agencies immediately, then notify my Big Brothers Big Sisters support staff.
I will always show respect for my Little and his/her family, and never come between a parent/guardian/state and the Little.
I will maintain regular monthly contact with Big Brothers Big Sisters of Central Nebraska (BBBS) support staff by responding to calls, letters, and e-mails and by completing required monthly match support. I will also complete evaluations as requested by BBBS staff.
I understand that if a problem arises in my match relationship or with my Little’s parent/guardian/state, I will contact BBBS support staff immediately to assess the situation and provide assistance in resolving the issue(s).
I will provide documentation of my automobile insurance and valid driver’s license annually.
I will always maintain open communication and never ask my Little to keep a secret.
If any of my contact information changes, I will notify BBBS immediately.
I understand the importance of properly ending a match relationship. Therefore, I will actively participate in the closure procedure as requested by BBBS support staff.
I will respect the personal space of my Little and avoid inappropriate physical contact (e.g., backrubs, sitting in laps, wrestling, etc.).
I agree to never leave my Little unattended or alone with any other person.
I agree to limit gift giving to special occasions and will receive prior approval from the parent/guardian or agency staff.
I agree to abstain from any use of alcohol, tobacco, or illegal drugs while in the presence of my Little, and I agree to avoid situations in which others are engaging in this type of activity.
I will never use corporal punishment with my Little or any means of verbal and/or emotional abusive means of discipline.
I will never display or discuss any materials of a sexual nature with my Little. (Please use good judgment with age/situation appropriateness, i.e., movies, teen pregnancy, etc.)
I agree to notify BBBS of situations that may arise in my life that may affect my match, including but not limited to serious illness, change in marital/family status, contact with law enforcement, etc.
I accept complete responsibility for my actions as a volunteer with Big Brothers Big Sisters of Central Nebraska. I agree to hold Big Brothers Big Sisters of Central Nebraska and all the members, agents, representative, and employees of that organization harmless and free from liability for my actions as a volunteer in the Big Brothers Big Sisters.

I agree to work within this agency’s ground rules. Failure to comply with these rules may be grounds for termination with the agency.

I have read the above requirements, which define my responsibilities as a volunteer with Big Brothers Big Sisters. I agree to abide by them as long as I am in the program.

Application Acknowledgement

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters. I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.

I have answered these questions honestly and completely to the best of my knowledge.

Contact Information