Community-Based Program Application

Volunteer Application

Mission:

Provide children facing adversity with strong and enduring, professionally supported one-to-one relationships that change their lives for the better, forever.

Mentoring Opportunities

Community-Based Programs:

Big Brothers, Big Sisters, Big Couples (married), and Big Families: These programs are designed to match children between 5 and 15 years old, with an adult who can serve as a positive role model, giving a child a chance to see their unlimited potential and providing the opportunity to develop into a more responsible, successful, well-rounded individual.

Outdoor Adventure Program is designed to instill in children a lifelong enthusiasm and respect for hunting, fishing, wildlife and habitat conservation, and landowner appreciation while providing a complete realistic hunting experience. Hunter safety is emphasized.

Mother Mentor Program is designed to match experienced mothers with new or expectant mothers. The goal of the program is to provide friendship and emotional support as well as relevant educational and parenting information.



Site-based Programs:

School-Based Mentor Program is designed to help children reach their potential at school but isn’t limited to the classroom. Littles talk with their Bigs about class, do homework or read together. It’s about starting a friendship, providing guidance and inspiring children to succeed.

Mustang Round-Up is a staff supervised group mentoring program specifically for General Beadle students. It meets on early release Wednesdays at General Beadle and is led by high school student volunteer mentors.

Campus Kids is a staff supervised group mentoring program specifically for children waiting for a Big Brother or Big Sister. It meets once a week on the SD School of Mines & Technology campus and is led by college student volunteer mentors.



Volunteer Requirements

Volunteer Mentors must:

• Be at least 16 years of age for School Mentoring, 18 years of age for Community Mentoring, 21 years of age for Outdoor Adventure Mentoring

• Be able to serve as a positive role model for a child or new mother

• Inform BBBS agency of any misdemeanor or felony charge, arrest, conviction, pardon or any suspended imposition of sentence incurred during the intake process and/or the match – including violations with Game Fish and Parks

• Be willing to spend one hour each week with a child or new mom in a Community Based Program, School Based Program, or Campus Kids

• Be willing to commit to at least 1 year in the agency’s Community Based Programs, 1 school year in the agency’s School Based Program, or 1 semester in Campus Kids

• Be free of drug and alcohol abuse or treatment for 3 years

• Have a valid driver’s license, access to an insured vehicle, and proof of insurance (with the exception of the School Based Program)

The Volunteer Mentor enrollment process consists of:

• An office interview

• A home interview (for community-based programs)

• Providing personal references

• Consenting to a police background check (for those 18 years old and older)

• Completing all necessary volunteer training

Along with this application, you will be asked to submit a copy of a government-issued photo ID, as well as your driver’s license (if not used as your government-issued photo ID), and proof of auto-insurance, if you plan to transport a child within the community-based program. All applications will be given equal consideration regardless of race, age, sex, disability, marital status, sexual orientation, religion or national origin.



Volunteer Application Form
  • Check the program you are most interested in volunteering for*(Big Couple and Big Family – each person must complete an application)
    Big Brother
    Big Sister
    Big Family
    Outdoor Adventure
    Mother Mentor
    School Mentor
    Campus Kids
    Mustang Round-Up
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  • GENERAL INFORMATION
    1
  • First Name*
    2
  • Middle Name*
    3
  • Last Name*
    4
  • Preferred Name*
    5
  • Home Phone*with Area Code
    6
  • Work Phone*with Area Code
    7
  • Cell Phone*with Area Code
    8
  • Is it ok to text you?*
    Yes
    No
    9
  • Home Street Address*
    10
  • City*
    11
  • State*
    12
  • ZIP*
    13
  • E-mail*
    14
  • How do you prefer to be contacted?*(Phone, e-mail, time of day, etc.)
    15
  • Date of Birth*
    16
  • Gender*
    Male
    Female
    17
  • Marital Status*If applicable, maiden name:
    18
  • Race/Ethnicity*
    American Indian or Alaska Native
    Native Hawaiian or Pacific Islander
    Asian
    White
    Black or African American
    Hispanic or Latino
    Other
    Multi-race
    19
  • Occupation*
    21
  • How Long Employed?*
    22
  • Work Hours?*
    23
  • Can you receive calls at work?*
    Yes
    No
    24
  • Highest level of education:*
    25
  • Area of study:*
    26
  • Are you a student at this time?*
    Yes
    No
    27
  • Do you have current or past military experience?*
    Yes
    No
    29
  • Are you retired?*
    Yes
    No
    33
  • Are you separated/discharged (other than retired)?*
    Yes
    No
    34
  • Possession of a driver’s license is required if you will be transporting a program youth in any vehicle you are operating.
    While we are not asking for that information here at this time, you may be required to provide it later upon request.
    36
  • Do you have a vehicle?*
    Yes
    No
    37
  • Do you have valid insurance that meets or exceeds state required minimum?*
    Yes
    No
    38
  • Q&A
    39
  • How did you hear about our program?*
    40
  • Have you previously applied to be or served as a Big Brother or Big Sister here or anywhere else?*
    Yes
    No
    41
  • Have you ever been involved with Big Brothers Big Sisters in a capacity other than a Big?*
    Yes
    No
    43
  • Have you ever been involved with or volunteered for another youth organization?*
    Yes
    No
    45
  • Have you ever been denied acceptance or released from service as a volunteer or employee for another Big Brothers Big Sisters program or youth-serving organization?*
    Yes
    No
    47
  • Are you interested in learning about additional ways to contribute to the Big Brothers Big Sisters mission?*
    Yes
    No
    49
  • REFERENCE INFORMATION
    51
  • Please list information for four references below including: • Your spouse or domestic partner (i.e., if you live with a significant other/ girlfriend/boyfriend) OR a family member, if you do not have a spouse, partner, or significant other) • Current or former employer 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
    52
  • Spouse/Partner's Name*
    53
  • Family Member Name*if no spouse/partner)
    54
  • Street*
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  • City*
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  • State*
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  • Zip*
    58
  • Day Phone*
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  • Cell Phone*
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  • Email*
    61
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  • Employer or Co-worker*(current or past) or school personnel (if you are a student)
    63
  • Street*
    64
  • City*
    65
  • State*
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  • Zip*full name
    67
  • Day Phone*
    68
  • Cell Phone*
    69
  • Email*
    70
  • 71
  • Friend, Neighbor, or other personal reference*
    72
  • Street*
    73
  • City*
    74
  • State*
    75
  • Zip*
    76
  • Day Phone*
    77
  • Cell Phone*
    78
  • Email*
    79
  • 80
  • Friend, Neighbor, or other personal reference*
    81
  • Street*
    82
  • City*
    83
  • State*
    84
  • Zip*
    85
  • Day Phone*
    86
  • Cell Phone*
    87
  • Email*
    88
  • 89
  • In addition to the references above, Big Brothers Big Sisters requires references from all youth serving organizations at which you have worked or volunteered in the past.
    90
  • Organization name*
    91
  • Direct supervisor*
    92
  • Street*
    93
  • City*
    94
  • State*
    95
  • Zip*
    96
  • Day Phone*
    97
  • Cell Phone*
    98
  • Email*a valid email address
    99
  • Dates of involvement or employment:*
    100
  • Reason for leaving:*
    101
  • 102
  • Organization name*
    103
  • Direct supervisor*
    104
  • Street*
    105
  • City*
    106
  • State*
    107
  • Zip*
    108
  • Day Phone*
    109
  • Cell Phone*
    110
  • Email*
    111
  • Dates of involvement or employment:*
    112
  • Reason for leaving?*
    113
  • 114
  • Organization name*
    115
  • Direct supervisor*
    116
  • Street*
    117
  • City*
    118
  • State*
    119
  • Zip*
    120
  • Day Phone*
    121
  • Cell Phone*
    122
  • Email*
    123
  • Dates of involvement or employment:*
    124
  • Reason for leaving?*
    125
  • CONSENT / UNDERSTANDING
    126
  • 1. The references and youth serving-organizations I listed may be contacted by mail, telephone, email, or in-person 2. 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, military records, and other records where required by local, state, or federal law for volunteers working with youth 3. I am in no way obligated to perform any volunteer services 4. 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 5. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references 6. As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview, home interview, and the necessary training 7. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law and with exceptions noted below 8. I understand that incidents of child abuse or neglect, past or present, must be reported to proper authorities 9. 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) 10. 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.) 11. I agree to timely communication and follow-up with all agency staff
    127
  • Signature*Type your full name. This will act as your signature
    128
  • Date*
    129
  • If applicant is under the age of 18, co-signature of a parent/guardian is required.
    130
  • Parent or Guardian Signature*Type your full name. This will act as your signature
    131
  • Date*
    132
  • Please read the following carefully before signing this application: 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, correct 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 on 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 occurrences. I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.
    133
  • Signature*Type your full name. This will act as your signature
    134
  • Date*
    135
  • If applicant is under the age of 18, co-signature of a parent/guardian is required for application and to obtain criminal history record check information.
    136
  • Parent or Guardian Signature*Type your full name. This will act as your signature
    137
  • Date*
    138
  • TALENT / MEDIA RELEASE
    139
  • I hereby consent to the use, sale, reproduction, transfer, or conveyance, of any and all photographs, images, likenesses, and voice recording of me in all forms (with or without the use of my name) by Big Brothers Big Sisters of the Black Hills, or by any designee of the Agency. I hereby consent to the use of all forms of media including advertising, trade, display, editorial, art, exhibition, and Agency newsletters (with or without my photograph and / or my name). I hereby give this consent and release to Big Brothers Big Sisters of the Black Hills, their nominees and designees from liability for any violation of any personal or proprietary right and agree to hold Big Brothers Big Sisters of the Black Hills harmless from all liability from the use, sale, reproduction, transfer or conveyance of the aforementioned items.
    140
  • Please check one:*
    I have read this document, understand it is a release of all claims, and consent to the above.
    I do not consent to the above.
    141
  • Signature*Type your full name. This will act as your signature
    142
  • Date*
    143
  • If applicant is under the age of 18, co-signature of a parent/guardian is required
    144
  • Parent or Guardian Signature*Type your full name. This will act as your signature
    145
  • Date*
    146
  • VOLUNTEER PRE-INTERVEW QUESTIONNAIRE
    147
  • Prior to your in-person interview, please answer the questions below. Parents of youth in our programs will often ask questions about someone with whom their child will be matched. 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.
    148
  • Do you have any concerns about your ability to fulfill the 12-month commitment required of mentors?*
    Yes
    No
    149
  • Do you anticipate any significant life changes over the next year or had any this past year?*
    Yes
    No
    150
  • Have you ever been accused, arrested, charged, or convicted of a crime?*
    Yes
    No
    152
  • Have you had any driving citations and/or moving violations in the past 5 years?*
    Yes
    No
    153
  • Do you have guns, ammunition, or other weapons in your house?*
    Yes
    No
    154
  • Are you experiencing any physical or mental health issues?*
    Yes
    No
    155
  • Do you speak any foreign languages?*
    Yes
    No
    156
  • Is there anything else you’d like to tell us about yourself or any questions that you have?*
    157
  • Are there other people living in your household? Provide name, age, relationship to you.*
    158
  • Please list any counties and states that you have lived in aside from your current address in the past 5 years.*
    159
  • I have answered these questions honestly and completely to the best of my knowledge.
    160
  • Signature*Type your full name. This will act as your signature
    161
  • Date*
    162
  • 163