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 Community-Based Volunteer Application:

Personal Information

Name: *
Date of Birth: *
Address: *
City: *
State: *
Zip: *
Email: *
Phone: *
Marital Status: *
Gender: *
Race/Ethnicity: *


Current Employer:
Job Title:
Work Phone Number:
May we call you at work?
Are you currently a student?
School Address:
School City:
School State:
School Zip:

Additional Information

Have you ever lived outside of Pennsylvania in the last 10 years?
Do you anticipate a job change/move in the next year?
Do you have access to an automobile?
Do you have a valid driver's license?
Have you ever applied for a job at Family Services of NW PA?
Have you ever been involved with the Office of Children and Youth?
Have you ever been a Big Brother or Big Sister?
If so, where?


Big Brothers Big Sisters of Family Services of NW PA requires that three positive references be obtained from: Spouse/Spousal Equivalent, Professional/School, and Personal. A fourth reference is required from youth serving organization(s) if applicant has disclosed relevant volunteer or paid experience with youth within the last 5 years.

Reference #1: Spouse/Spousal Equivalent
Reference 1 Name: *
Reference 1 Address: *
Reference 1 City: *
Reference 1 State: *
Reference 1 Zip: *
Reference 1 Email: *
Reference 1 Phone: *

Reference #2: Professional/School
Reference 2 Name: *
Reference 2 Address: *
Reference 2 City: *
Reference 2 State: *
Reference 2 Zip: *
Reference 2 Email: *
Reference 2 Phone: *

Reference #3: Personal
Reference 3 Name: *
Reference 3 Address: *
Reference 3 City: *
Reference 3 State: *
Reference 3 Zip: *
Reference 3 Email: *
Reference 3 Phone: *

Reference #4: Youth-Serving Organization (only if applicable)
Reference 4 Name: *
Reference 4 Address: *
Reference 4 City: *
Reference 4 State: *
Reference 4 Zip: *
Reference 4 Email: *
Reference 4 Phone: *

Volunteer Preferences

In which area of town do you live? *
In which areas of town are you willing to travel to see your Little? *
GENDER: Do you have a preference as to the gender of a child? *
AGE: Which age group do you feel most comfortable being matched with? *
ETHNICITY: Which race/ethnicity do you feel most comfortable being matched with? *
COMPREHENSION: Which comprehension level would you feel most comfortable working with? *
PROBLEM AREAS: Please select any general behavior and problem area you would NOT be willing to deal with. *
ACTIVITIES AND INTERESTS: Please select the following areas of interest. *
Other talents and hobbies you would like to share with the child:

Applicant's Statement

By signing this application, I agree to engage in the mentoring match for at least one year. I also agree to inform Big Brothers Big Sisters of Family Services of NW PA of any infractions of the law including motor vehicle violations. My signature also gives Big Brothers Big Sisters of Family Services of NW PA permission to complete a criminal background check, including: Child Line, State Police Clearance, and National Sex Offender Registry. My name will also be verified against the Judicial System of Pennsylvania Web Portal. I understand that all information about me will be confidential. I agree to comply with all policies and procedures of Big Brothers Big Sisters of Family Services of NW PA.
Applicant Signature *


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