About You

Your Name:(Required)

About the Applicant

Name of person reference is being provided for:(Required)
Where does this person live?(Required)
1. Would you recommend the applicant as a mentor for a child or youth?
8. Are you aware of anything that might interfere with the applicant's ability to mentor or would cause their commitment to our organization to come to an end?
8. Can the applicant be counted on to follow through on commitments?
9. Would you allow the applicant to develop a one-on-one relationship with a child you care about?
11. Have you ever known the applicant to be emotionally, physically, verbally or sexually inappropriate with either adults or children?
12. To your knowledge, has the applicant ever had any trouble following rules?
14. Has the applicant experienced an addiction, health or emotional concern that may impact their ability to participate actively in a match?
15. Would anything need to change in the applicant's home to be suitable for a child's visit?
FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: Are you supportive of your partner/significant other’s application to become a mentor with Big Brothers Big Sisters?
FOR PARTNERS/SIGNIFICANT OTHER'S ONLY: Are you are of any complaints being made or disciplinary actions being taken against your partner/significant other?