Young Black and Brilliant Volunteer Interest Survey

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in volunteering. Please fill out the information below and one of our team members will contact you.

Email *

Today's Date *

YYYY

First Name *

Last Name *

Date of Birth *

YYYY

Phone number *

Address *

Which category describes you? Select all that apply *

Black or African American

White

Asian

Hispanic, Latino or Spanish origin

Middle Eastern or North African

Native Hawaiian or Pacific Island

Multi-ethnic

Prefer not to disclose

Required

Pre-Interview Questions

Given the nature of our youth program, Young Black and Brilliant prioritizes a thorough screening process for potential volunteers. Parents of youth participants often inquire about our volunteers, and we reserve the right to decline applications that may not align well with our program. The decision to refuse an application may encompass considerations beyond those explicitly mentioned. Young Black and Brilliant strictly adheres to a non-discriminatory policy, refraining from any bias based on race, sexual orientation, gender identity, or religion. *

Have you volunteered with YB&B before? *

Yes

How did you hear about our program? *

Employer/ Job Title or Professional Role:

To better match you with the right opportunities, please briefly tell us about your skills, experience, talents or passions?

Would you be interested in sharing your work or skills with the youth (e.g., career talk, workshop, mentoring)?

Yes

Maybe

Clear selection

How many books have you read in the last 3 month? *

0 books

1-4 books

5 or more books

I’m Interested In: (Check all that apply) *

Assist with youth sessions (setup, greet, check-in, lead fun activities, clean up)

Lead or co-lead book discussions with youth

Read and preview youth book selections in advance

Hosting a workshop or teaching a life skill (e.g., cooking, budgeting, self-esteem)

Support fundraisers efforts and special community events

Donating items, services, or supplies

Required

How long would you like to commit to volunteering with YB&B youth? *

One-time only (e.g., guest speaker, workshop host)

Short-term (1–3 months)

School-year commitment (September–June)

Occasional (as needed for events, fundraisers or special projects)

I’m not sure yet — I’d like to discuss options

Required

Are you willing to attend field trips /social events with the kids? *

Yes

Required

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

Yes

Other:

Have you been convicted of a felony or released from prison within the last ten (10) years, or have you been convicted of a misdemeanor other than minor traffic offenses within the past three (3) years? *

Yes

If yes to being convicted of a felony or misdemeanor other than minor traffic offenses please explain: *

Have you been accused of, charged, or convicted of any form of child abuse? *

Yes

Are you currently involved in any pending criminal charges? *

Yes

Are you using this program to fulfill community service hours for a criminal conviction? *

Yes

Are you available in the evenings? *

Yes

Media Release
I hereby grant the Young Black and Brilliant {YB&B} permission to use photograph, video, or other digital media (“photo”) in any and all of its publications, social media including web-based publications, without payment or other consideration. *

I (select answer below) consent to use images and consent to use my name in promotional materials for {YB&B) *

Yes, I grant consent

No, I do not grant consent

Required

Any additional information you would like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms