Volunteer Application

Apply to be a part of our community!

Volunteer Type(Required)

Legal Name(Required)

First Middle Last

Preferred Name

First

Previous Last Name (If Applicable)

Last

Local Phone

Work Phone

Cell Phone(Required)

Date of Birth(Required)

SSN

Email(Required)

Local Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Gender(Required)

Gender (write in)(Required)

Marital Status(Required)

Ethnicity(Required)

Background

Highest Grade Level Completed(Required)

Employer(Required)

Occupation (If Student, Where?)(Required)

Can We Contact You at Work?(Required)

Work Hours(Required)

How Long Have You Been Employed?(Required)

Is your permanent address different from your local address?(Required)

Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

County(Required)

Name of Spouse (If Applicable)

First Last

Children Name & Age (If Applicable)

List other residences within the past five years (Address & Date)

Transportation

Possession of a driver’s license is not a requirement to participate in any of our programs but is required if you will be transporting a youth in any vehicle you are operating.

Do you have a driver's license?(Required)

State of Issue(Required)

License Number(Required)

Expiration Date(Required)

Do you own or have access to reliable transportation?(Required)

Copy of Car Insurance

Max. file size: 50 MB.

Have your driving privileges ever been suspended or revoked?(Required)

If yes, please explain the offense and length of suspension or revocation.(Required)

Background

Have you ever been arrested, charged or convicted for a misdemeanor or felony?(Required)

If yes, list below the offense, dates, jurisdiction location and disposition.(Required)

Do you currently have any pending court actions?(Required)

If yes, please explain.(Required)

Previous Experience

Have you ever applied before (or have been) to be a Big Brother or Big Sister?(Required)

When & Where?(Required)

What, if any, other youth organizations have you worked for or been involved with as a volunteer?

Name of Organization

City/State

From/To

Office Held

Name of Organization

City/State

From/To

Office Held

Name of Organization

City/State

From/To

Office Held

References

Please list four people you have known for at least one year including your immediate supervisor, past supervisors, professors, and roommate(s) (if applicable), and spouse/significant other as references.

1. Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Day Phone

2. Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Day Phone

3. Name

First Last

Relationship

Address

Street Address Address Line 2 City State ZIP Code

Day Phone

Activity Checklist

Check each activity you either like or think you might want to try.

Sports

Sports (Other)

Arts & Crafts

Arts & Crafts (Other)

Outdoors

Camping

Fishing

Hunting

Gardening

Beach

Hiking

Picnics

Other

Outdoors (Other)

Games

Cards

Chess

Checkers

Board Games

Video Games

Other

Games (Other)

Science/Mechanics

Auto Mechanics

Airplanes

Chemistry

Electronics

Computers

Musical Instruments

Other

Science/Mechanics (Other)

Additional

Movies

Sightseeing

Concerts

Museums

Reading

Zoos

Shopping

Plays

Other

Additional (Other)

Hobbies

Of all the activities listed above, which 3 would you like to do most?

Do you have any pets? What Kind?

What things do you collect?

What are your favorite TV programs?

What clubs/groups do you belong to?

PLEASE NOTE: A COPY OF THIS CHECKLIST MAY BE GIVEN TO YOUR LITTLE AT THE INITIAL MATCH (FIRST MEETING).

Legal

Name of Volunteer(Required)

First Middle Last

Date(Required)

Signature of Volunteer(Required)

Name of Volunteer(Required)

First Middle Last

Date(Required)

Signature of Volunteer(Required)

Big Brothers Big Sisters retains the right to accept or deny participants or close a match at any time. Should we notify you that you are not accepted as a volunteer Big, you may appeal by:

Grievance Procedure: An aggrieved program participant (i.e., applicant, volunteer, parent/guardian of a child, child) should discuss their grievance with their Enrollment and/or Match Support Specialist. If such a step does not bring resolution, the aggrieved party may appeal to the Program Director. If such a step does not bring resolution, the aggrieved party may appeal to the CEO. If a satisfactory conclusion cannot be reached by this point, the aggrieved party can request that their case be reviewed by the Executive Committee of the Board of Directors. The Executive Committee will make its recommendation to the Board of Directors. All decisions of the Board of Directors are final.

The information given in this application is correct and accurate to the best of my knowledge. I have reviewed all my responses before forwarding this document to Big Brothers Big Sisters of Northcentral Wisconsin. Further, I understand and agree that as part of the Big Brothers Big Sisters enrollment process, agency personnel will obtain personal information about me from references, public records, interviews, and other sources as deemed necessary for program participation. I understand and agree that as part of the Site-Based mentoring with the Boys and Girls Club of the Wausau area (if applicable), Big Brothers Big Sisters of Northcentral Wisconsin may share feedback and information with the Boys and Girls Club. By signing this application, I hereby release and indemnify Big Brothers Big Sisters of Northcentral Wisconsin, Inc., the Boys and Girls Club of the Wausau area (if applicable), its officers, board of directors, staff, and participants from and against all claims and liability for negligence, willful misconduct, or sexual abuse relating to my participation in this program.

Please be advised that under Wisconsin law volunteers are not considered “workers” and therefore are not covered by a workers’ compensation policy. You are advised to check the adequacy of your own personal health coverage before volunteering for Big Brothers Big Sisters of Northcentral Wisconsin.

Name of Volunteer(Required)

First Middle Last

Date(Required)

Signature of Volunteer(Required)

Donations

There are many costs associated with becoming a volunteer with our youth serving organization. Please take a moment and consider donating.

Would you consider supporting Big Brothers Big Sisters of Northcentral Wisconsin by helping to cover the cost of your enrollment expenses?

Yes, I would like to donate $20 to cover the cost of my enrollment

Yes, I would like to donate a different amount

Donation Amount(Required)

Would you like to make this a reoccuring donation?(Required)

Donation Type(Required)

Venmo @bbbsncw (verification code 3684)

Visa

Master Card

Discover

American Express

Credit card transactions will be processed on the next business day.

Name (as it appears on card)(Required)

Credit Card Number(Required)

Expiration Date(Required)

MM/YY

CCV(Required)

3 digits on back of card, unless American Express then 4 on front)

Card Holders Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Signature(Required)

Date(Required)