Big Friend Application

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Big Friend Application

Name(Required)

First Last

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Permanent Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number(Required)

Birthday(Required)

Email(Required)

Education Level(Required)

College/High School Attending

Year in College/High School

Major/Minor (if student)

Big Friend Occupation(Required)

Are you bilingual?(Required)

Yes

Race(Required)

American Indian/Alaska Native

Asian

Black/African American

Hispanic

Native Hawaiian/Other Pacific Islander

White

Other Race

Multiple Races

Check if providing proof of auto insurance

Yes, I will be providing auto insurance.

Name of Insurer

Hobbies/Interests(Required)

Current Employment

Number of hours worked per week

References

List three professional character references, unrelated to you, who have known you at least one year, and who are not under your supervision at work or school:

Reference #1(Required)

First Last

Reference #1's Email

Reference #1's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #2(Required)

First Last

Reference #2's Email

Reference #2's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #3(Required)

First Last

Reference #3's Email

Reference #3's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Check here giving your permission for these three references to be contacted by the Friends Director.

Yes, the Friends Cordinator may contact these three references.

Check here giving permission for Friends to conduct a background check using public records.

Yes, Friends may conduct a background check using public records.

Little Friend

I prefer a(Required)

Boy

Girl

Either

Grade Level(Required)

K-1st

2nd-3rd

4th-5th

Any

Comment

I agree to give one hour a week to my Little Friend. I understand that I am not responsible for expenses other than for myself. I agree to keep a written report of the time spent with my Little Friend and to communicate with the Friends Director regularly, especially should any concerns arise.

Check here if you agree and understand the paragraph above.