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Littles Inquiry

All information that you submit through this application will be sent to a secure database and only Big Brothers Big Sisters employees will be able to view the information.

When BBBS staff receives your child’s inquiry (below), we will automatically mail an application to the address you submit. If you have not received the paperwork within a week of submitting this online inquiry, please contact our office at 812-334-2828. Please fill out the application and return it in the enclosed envelope. Upon receiving the application, a member of our case management staff will contact you to schedule a time to meet with you and your child. Thank you for your interest in Big Brothers Big Sisters!

Please provide the following information about the child:

(* represents required fields)

*First name
*Last name
*Birthdate
*Gender
*Street Address
*City
*State
*Zip Code
School
Grade
*Parent/Guardian First Name:
*Parent/Guardian Last Name:
*Relationship to Child
Home Phone
Cell Phone
Work Phone
Email
*May we call you at work?	Yes No

AFFIRMATIVE ACTION POLICY

* I understand that not all children may be considered for a BB/BS or that a BB/BS will found for my child/ward and that BBBS has an Affirmitive Action Plan and does not discriminate in any way because of race, sex, sexual orientation, color, religion, age, national origin, or income.

© 2005 Big Brothers Big Sisters of South Central Indiana. All Rights Reserved Designated trademarks and brands are the property of their respective owners. Privacy Statement
Monroe County Office 418 South Walnut Street Bloomington, Indiana Phone: (812) 334-2828 Fax: (812) 334-1718		Owen County Office 6 W Market St. Spencer, Indiana 47460 Phone: (812) 828-9331

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