Community Based Parent/Youth Application
Thank you for your interest in enrolling a child! Please complete the application as detailed as possible. Once you submit the application, someone from the agency will be in contact with you to schedule an in-home interview.
* Required
Parent/Guardian Name
*
First and last name
Your answer
Relationship to Child
*
Your answer
Child's Name
*
First and last name
Your answer
Do you have legal custody of the child?
*
Yes
No
Is there a person who shares legal custody of this child?
*
Yes
No
If answered yes to the above, are they aware and supportive of the child's enrollment in BBBS? Please provide their name, address, and phone number.
Your answer
Child's Gender
*
Your answer
Child Date of Birth
*
MM
/
DD
/
YYYY
What is the child's living situation?
*
Two-Parent Household
One-Parent Household (Female)
One-Parent Household (Male)
Other Relative of Child (Non-parent)
Foster Home/Group Home
Other
Required
Email
*
Your answer
Phone number
*
Your answer
Can we text this number?
*
Yes
No
Address
*
Street, City, State, Zip
Your answer
Number of people (adults and children) in household:
*
Your answer
Is parent/guardian receiving income assistance at this time?
*
Yes
No
Is parent/guardian receiving assistance with housing (e.g. Section 8, residence in public-housing, etc.)?
*
Yes
No
Is child eligible for free or reduced lunch?
*
Yes - Free
Yes - Reduced
No
Household Annual Income: (total income of the adults the child lives with)
*
$0-$10,000
$10,001-$15,000
$15,001-$20,000
$20,001-$30,000
$30,001-$50,000
$50,001+
Does your child have a parent/caregiver with current or past military experience?
*
Yes
No
If yes to the question above, please state who the parent/caregiver is and list dates of service
Your answer
Does the child have a parent/guardian who is currently incarcerated? If yes, please explain.
*
Your answer
Child's School and Grade
*
Your answer
Within the last year, has child been in trouble at school?
*
Please check all that apply.
Poor Grades
Skipping school/classes
Truant
Behavior Problems
Suspended
Expelled
Sent to an alternative school
None
Required
Race/Ethniciy
*
Check all that apply
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other
Required
Parent/Guardian Place of Employment
*
Your answer
May we contact you at work?
*
Yes
No
If we are unable to reach you, who is someone we could call who always knows how to reach you? Please include Name & Phone #
Your answer
What is the primary reason for wanting your child to have a Big Brother or Big Sister?
*
Your answer
Does your child know that you are applying for this program?
*
Yes
No
Does your child want to participate in the BBBS Program?
*
Yes
No
Where did you hear about Big Brothers Big Sisters?
*
Please check all that apply
School
Relative
Faith Organization
Service Organization
Website
TV/Radio
Event
Social Media
Other
Required
Does your child have siblings or relatives who are applying for the BBBS Program at this time or who are currently in the program? If yes, please provide their name.
*
Your answer
Do you plan on moving out of Marquette/Alger County in the next year or two? If yes, please explain.
*
Your answer
Will your child be able to meet with their Big Brother/Big Sister for a minimum of 4-6 hours a month for one-year commitment?
*
Yes
No
Does your child have any medical conditions that might affect them from participating in activities with their Big Brother/Big Sister? If yes, please explain.
*
Your answer
Has child ever been arrested or involved in the juvenile justice system? If yes, please explain.
*
Your answer
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