Volunteer Application

Your Name *

Email Address *

Address *

City *

State *

Zip/Postal Code *

Phone *

Phone Type *

Birthdate * +

Gender *

Male

Female

Ethnicity *

Occupation *

Do you have your own transportation? *

Yes

No

Are you willing to travel to visit a Little? *

Yes

No

Are you willing to be matched for a minimum of 1 year? *

Yes

No

Have you ever applied to be a Big Brother/ Big Sister before? *

Yes

No

Please list any arrests, convictions, and recent traffic violations. In addition, please include the date and disposition/result of the charge.

+-

Please Provide the Following Three (3) References

Please let your references know that we will be contacting them, and that the reference must be completed to ensure the most timely processing of your application. All references must be over the age of 18.

1. Spouse or Signifcant Other Reference

(If none, please list a relative)

Name *

Phone *

How are you related? *

2. Colleague Reference

(Please provide someone you've known for 2+ years)

Name *

Phone *

3. Friend Reference

(Please provide someone whom you have known for 2+ years and is familiar with your home environment.)

Name *

Phone *

Big Brothers/Big Sisters of the Twin Tiers, Inc. is hereby authorized to investigate and verify all statements made in this application to conduct any further investigation it deems necessary to determine my suitability for volunteer service. I release Big Brothers/Big Sister of the Twin Tiers, Inc. and its staff from any liability in connection with such an investigation.

Volunteer Signature and Date *

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