BBBS of Warren & Clinton Counties, Inc.

School Based Mentoring

School Based Mentoring Program -
Through a partnership between local schools and Big Brothers and Big Sisters, volunteer opportunities are now available. Volunteers visit with children for one hour each week to provide extra attention and help with schoolwork.

This is a nine to twelve month commitment with some programs holding three activities over the summer break. During thier weekly visit, the child and his Brother or her Big Sister may play educational games, work on homework, read a book together, and essentially develop a friendship. Teachers make sure that the time of the visit does not interfere with regular classroom learning.

Schools include:
Lebanon: Donovan Elementary, Berry Intermediate

Franklin: Anthony Wayne Elementary, Pennyroyal Elementary

Kings: Kings Jr High

Mason: Western Row Elementary

To be a School Based Mentor please fill out application below. There will be a confirmation email sent to verify the information has been submitted.

School Based Mentoring - Adult Online Application

High School students should fill out the High School School Based Mentoring Application. Located below.

Adult SBM - Full Name (First, Middle, Last)
Date of Birth and Age
Social Security Number
Address (# and Street, City, State, Zip, and County in State)
Length of Residence
E-mail Address (if any)
Home Phone	() -
Cell Phone	() -
Gender, Race, Religion
Education (where & what degree earned)
Occupation & Employer Name
Employer Address (# and Street, City, State, Zip)
Length of Current Employment
Work Phone	() -
Can you be contacted at work? What are your work hours?
Why do you want to be a Big Brother/Big Sister?
Prior volunteer experience
Prior experience with children
Do you anticipate changes in residence status in the next year? If YES, please explain.
General Health, Current Medications, and Physical Limitations (if any)
Organizations in which you belong (fraternity, civic, religious, athletic, or other)
Has your driver's license ever been revoked or suspended? If yes, where and when did this occur? Please explain the details.
Have you ever been convicted of a crime? If so, please explain the details.
Do you object to the agency running a criminal background check?
REFERENCE #1's Name and Relationship to You (Person who has known you for more than one year and is NOT a relative -- employer, if possible)
REFERENCE #1's Home Phone, Cell Phone, Work Phone, and email address (if any)
REFERENCE #1's Address, City, State, Zip
REFERENCE #2's Name and Relationship to You (Person who has known you for more than one year and is NOT a relative)
REFERENCE #2's Home Phone, Cell Phone, Work Phone, and email address (if any)
REFERENCE #2's Address, City, State, Zip
SCHOOL BASED MENTOR AGREEMENT ~ As a potential mentor for the School Based Mentoring Program, I understand/agree to the following: ~ To be on time for scheduled meetings. ~ To notify the agency or school office if I am unable to keep my weekly meeting. ~ To engage in the relationship with an open mind. ~ To accept assistance from my mentee�s teacher. ~ To keep discussions with my mentee confidential. ~ To ask for assistance when I need help with my Little Brother or Sister from my Case Manager. ~ To notify the agency of changes in my employment, address, and phone number. ~ The BBBS agency is not obligated to match me with a youth. ~ As part of the enrollment processes, you will be asked to provide additional personal information prior to making any recommendations for assignment. ~ Signature and date (to be completed at interview)

School Based Mentoring - High School Online Application

High School SBM - Full Name (First, Middle, Last)
Date of Birth and Age
Social Security Number
Address (# and Street, City, State, Zip, and County in State)
Length of Residence
Home Phone	() -
Cell Phone	() -
Gender, Race, Religion
School & Current Grade Level
E-mail Address
Have you discussed becoming a Big Brother/Big Sister with your parents? If so, what are their feelings?
Occupation (if any) & Employer Name
Length of Current Employment
Why do you want to be a Big Brother/Big Sister?
Prior volunteer experience
Prior experience with children
Do you anticipate changes in residence status in the next year? If YES, please explain.
General Health, Current Medications, and Physical Limitations (if any)
Organizations in which you belong (fraternity, civic, religious, athletic, or other)
Has your driver's license ever been revoked or suspended? If yes, where and when did this occur? Please explain the details.
REFERENCE #1's Name and Relationship to You (Teacher, Coach, Guidance Counselor, Principal, etc. who knows you well)
REFERENCE #1's Work Phone and E-mail Address
REFERENCE #1's Address, City, State, Zip
REFERENCE #2's Name and Relationship to You (Parent)
REFERENCE #2's Home Phone, Cell Phone, Work Phone, and E-mail Address (if any)
REFERENCE #2's Address, City, State, Zip
SCHOOL BASED MENTOR AGREEMENT ~ As a potential mentor for the School Based Mentoring Program, I understand/agree to the following: ~ To be on time for scheduled meetings. ~ To notify the agency or school office if I am unable to keep my weekly meeting. ~ To engage in the relationship with an open mind. ~ To accept assistance from my mentee�s teacher. ~ To keep discussions with my mentee confidential. ~ To ask for assistance when I need help with my Little Brother or Sister from my Case Manager. ~ To notify the agency of changes in my employment, address, and phone number. ~ The BBBS agency is not obligated to match me with a youth. ~ As part of the enrollment processes, you will be asked to provide additional personal information prior to making any recommendations for assignment. ~ Signature and date (to be completed at interview)

E-mail the webmaster: bbcarol@go-concepts.com

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