BIG BROTHERS BIG SISTERS SCHOOL-BASED MENTORING PROGRAM INFORMATION SHEET Mission To provide youth with positive mentoring relationships through a high-quality, one-to-one, volunteer program designed to help them become productive, self-reliant adults. School-Based Mentoring Program The School-Based Mentoring Program matches high school students with elementary and middle school students and adults with elementary through high school students. The matches meet in the school setting for one hour each week. The time is broken into three segments including; participating in group activities promoting trust, cooperation and social interaction, spending one-to-one working on academics as assigned by the Little Buddy's teacher, and having fun time with their Big Buddy. Volunteers The volunteers are carefully screened high school students and adults who are willing to commit to the program for a minimum of one school year. Each volunteer is screened for appropriate communication and social interaction skills and a desire to help a younger child. (High school students are also screened for appropriate academic scores.) Training and support are provided to each high school and adult mentor by Big Brothers Big Sisters. Children Served Children participating in the program are referred by their teachers or counselors. They have been identified as children who would benefit from a one-to-one relationship. The program is intended to provide support and assistance to young children to help them increase their self-confidence, social competence and ability to care. Benefits Benefits to the Volunteer  Enjoy the pleasure and fun of interacting with a younger child.  Understand the satisfaction one can derive from providing community-service.  Positive self-esteem and greater appreciation for diversity.  Obtain service-learning and community service experience, which is valuable on volunteer’s resumes and on college applications. Benefits to the Child  Extra time and attention on a one-to-one basis.  A new friend, close to their own age to look up to.  Enhanced confidence, competence and ability to care.  Exposure to new games, books and other resources and activities.  Better attendance at school and an improved attitude. If you have any questions about the School-Based Mentoring Program or would like more information about Big Brothers Big Sisters, please contact us at 453-5521.

Big Brothers Big Sisters School-Based Mentoring PARENT PERMISSION FORM 2016-2017 School Year

Dear Parent/Guardian: Students at your child’s high school have the opportunity to participate in the Big Brothers Big Sisters School Based Mentoring program called the Buddies Program. In the program, an elementary or middle school student is "matched" with a high school volunteer. This volunteer will visit their assigned elementary or middle school once a week to spend about one hour with their match: reading, working on schoolwork, playing games, sports, etc. The activities take place during the school day and at the school - not outside the school grounds. During the summer, however, we encourage limited contact between your child and his/her Little Buddy. Big Brothers Big Sisters will facilitate written contact between the match through the use of postcards. If you would like your son/daughter to have this opportunity, please fill out the permission slip below and return it to the school as soon as possible. I give permission (1) for my son/daughter to participate in the Big Brothers Big Sisters Buddies Program; (2) for the school to provide social, academic, and attendance information (specific to this school year, as well as last year’s for comparative purposes) about my child to Big Brothers Big Sisters (e.g. report cards, behavior reports, attendance records); (3) to use my child's photograph and first name for the purpose of publicity efforts by Big Brothers Big Sisters. Characteristics: Please place a check next to any of the following if you have any preferences regarding the child who may be matched with your son/daughter: • Race/ethnicity of the Little • Religion/faith of the Little • Any other preferences in the characteristics of the Little Note: Big Brothers Big Sisters does not discriminate on the basis of the above factors and Little’s with various characteristics may not be accepted, but you may have a preference about the Little who may be matched with your son/daughter and we will follow your preferences to the best of our knowledge and capability. Female children will only be matched with female volunteers. Male children can be matched with either a male or female volunteer. High School Student’s Name:

Date:

Parent/Guardian Name:

Date:

Relation to volunteer:

Date:

Parent/Guardian Signature:

Date:

BBBS BUDDIES VOLUNTEER APPLICATION Applicant Information Parent/Guardian’s Name:

Name:

Social Security # (required): ___________________ Gender: Home Address:

DOB:_________ Age: ____ Race: City:

Email: _________________________________________Home Phone: School:

Grade:

Employer:

Occupation:

G.P.A.:

State:

Zip:

Cell Phone: Counselor: Work Phone:

Do you have a driver’s license? Yes No Do you have current car insurance? Yes No *Note: Big Brothers Big Sisters needs a copy of your driver’s license and car insurance. Please bring both to your inperson interview. Reference Information Please print information requested for two references: 1) your school teacher/counselor; 2) your current or past employer or personal reference who is not related to you and is 18 yrs of age or older and give them a reference check form to return to BBBS. School Personnel Reference (School Teacher/Counselor) Name: Day Phone: Address: City: State: Zip: Email: How long have you known this person? (years and months) Employer or Personal Reference (No Relatives) Name: Day Phone: Address: City: State: Zip: Email: How long have you known this person? (years and months) I understand that it is necessary for Big Brothers Big Sisters of Great Falls to investigate my background and to check my references. Therefore, I hereby authorize and direct any and all employers, courts (juvenile and adult), police agencies, counseling agencies, social service agencies, and any other persons or agencies with whom I have had contact with to release any information concerning me which said persons and agencies may have. I hereby release said persons or agencies releasing information from any and all liability arising or said to arise from the furnishing of said information. This application in no way obligates me to perform any volunteer services and BBBS agency is not obligated to match me with a youth. As part of our enrollment process, BBBS will be asking you to provide additional personal information prior to making any recommendations for assignment. Applicant Signature:

Date:

Parent Signature:

Date:

Program Specialist Signature:

Date:

VOLUNTEER INSURANCE VERIFICATION Volunteer’s Name: _____________________________________________________________ Policy Holder’s Name: __________________________________________________________ Insurance Company: ____________________________________________________________ Agent’s Name: ________________________________________________________________ Agent’s Phone Number: _________________________________________________________ Policy Limits: _________________________________________________________________ Bodily Injury Limits: ___________________________________________________________ Property Damage: ______________________________________________________________ Or Combined Single Limits: Note:   

All volunteers are required to carry auto insurance in the amount required by the State. Please bring your insurance card to your in-person interview. Big Brothers Big Sisters is required to have a photocopy of your insurance card. You are required to notify Big Brothers Big Sisters of any changes in your auto insurance coverage.

________________________________________ Signature of Policy Holder

______________________ Date

VOLUNTEER DRIVER’S LICENSE VERIFICATION Driver’s License Number: 

Driver’s License Expiration Date:

Please bring your driver’s license to your in-person interview. Big Brothers Big Sisters is required to have a photocopy of your driver’s license.

WAIVER (If volunteer will not be driving) I have an alternative means of transportation and will not be driving my own vehicle.

Signature of Student

Date

Signature of Parent/Guardian

Date

2016-2017 School Year

Re: Big Brothers Big Sisters Buddies School-Based Mentoring Program Dear Reference, This student has applied to become a high school mentor and has given us your name as a reference. We would appreciate if you could answer and return the enclosed questionnaire. The information you provide will help Big Brothers Big Sisters assess the applicant’s ability to become a successful high school mentor. We assure you that your answers will be held in confidence. The program that the applicant is applying for is the Big Brothers Big Sisters School-Based Mentoring Program. This program matches high school students with elementary students. The matches meet in the school setting for one hour each week. The time is broken into three segments including; participating in group activities promoting trust, cooperation and social interaction, spending one-on-one working on academics as assigned by the Little Buddy's teacher, and having fun time with their Big Buddy. Big Brothers Big Sisters is looking for applicants that are responsible, dependable and willing to make a difference in a child’s life. With your help, we can assess this applicant’s ability to become a positive role model. On behalf of the applicant and Big Brothers Big Sisters, I would like to thank you for your assistance in this matter. If you have any questions about the program and/or concerns about the applicant, we encourage you to call our office at 453-5521. Please return this form to: Big Brothers Big Sisters Attn Katelyn Farrington 18 6th St N Ste 26 Great Falls, MT 59401 Or to the Counseling Office at your High School Attn: Julie Graham – CMR Attn: Jason Karls – GFH Attn: Eric Vincent- Central Sincerely,

Katelyn Farrington Program Director

REFERENCE CHECK Applicant’s Name:

Applicant’s School:

1.

How long have you known the applicant?

2.

In what capacity do you know the applicant?

3.

Can you tell me about their home environment, in particular how child friendly is it? Are there any safety concerns or anything else that you would have concerns about?

4.

Can you tell me about a time you observed this volunteer around a child or children?

5.

What were your impressions or feelings about the interactions?

6.

Do you know of any reasons why being a Buddy may not be the right experience for this volunteer?

7.

Do you know of any reason why this may not be the best time for the volunteer to commit to being a Buddy?

8.

What else would you like to tell us about this volunteer?

Reference Name: Reference Signature:

Phone Number: Date:

2016-2017 School Year

Re: Big Brothers Big Sisters Buddies School-Based Mentoring Program Dear Reference, This student has applied to become a high school mentor and has given us your name as a reference. We would appreciate if you could answer and return the enclosed questionnaire. The information you provide will help Big Brothers Big Sisters assess the applicant’s ability to become a successful high school mentor. We assure you that your answers will be held in confidence. The program that the applicant is applying for is the Big Brothers Big Sisters School-Based Mentoring Program. This program matches high school students with elementary students. The matches meet in the school setting for one hour each week. The time is broken into three segments including; participating in group activities promoting trust, cooperation and social interaction, spending one-on-one working on academics as assigned by the Little Buddy's teacher, and having fun time with their Big Buddy. Big Brothers Big Sisters is looking for applicants that are responsible, dependable and willing to make a difference in a child’s life. With your help, we can assess this applicant’s ability to become a positive role model. On behalf of the applicant and Big Brothers Big Sisters, I would like to thank you for your assistance in this matter. If you have any questions about the program and/or concerns about the applicant, we encourage you to call our office at 453-5521. Please return this form to: Big Brothers Big Sisters Attn Katelyn Farrington 18 6th St N Ste 26 Great Falls, MT 59401 Or to the Counseling Office at your High School Attn: Julie Graham – CMR Attn: Jason Karls – GFH Attn: Eric Vincent- Central Sincerely,

Katelyn Farrington Program Director

REFERENCE CHECK Applicant’s Name: 9.

Applicant’s School:

How long have you known the applicant?

10. In what capacity do you know the applicant?

11. Can you tell me about their home environment, in particular how child friendly is it? Are there any safety concerns or anything else that you would have concerns about?

12. Can you tell me about a time you observed this volunteer around a child or children?

13. What were your impressions or feelings about the interactions?

14. Do you know of any reasons why being a Buddy may not be the right experience for this volunteer?

15. Do you know of any reason why this may not be the best time for the volunteer to commit to being a Buddy?

16. What else would you like to tell us about this volunteer?

Reference Name: Reference Signature:

Phone Number: Date: