Mentee Enrollment Application - Big Brothers Big Sisters of the Battlefords

youth's Info:

Youth's Full Name (including middle name):*

How does your youth identify (male, female, transgender, two-spirited, etc):

Which pronoun should be used to identify them? (Eg: he, she, ze, they, etc)

Youth's Birthdate:*

Current School Attending and Grade:*

Parent/Guardian Info:

Name (Including First and Last Name):*

Relationship to the Youth:*

Email Address:*

Street Address (including City and Postal Code):*

Postal Address (if different from street address):

Any plans to move?*

Yes
No

If yes, when and where are you planning to move?

Contact Number:*

Are you employed? Where do you work?*

Can you be contacted at work?:*

Yes
No

Work Phone Number:

When is the best time to contact you and what way do you prefer?*

In cases of joint custody, we must receive consent from both parents to proceed. If applicable, please let us know which Custody Agreement applies to the youth you are applying for.

Custody Agreement:

Sole
Joint

Other Parent/Guardian(s) Name(s):

Relationship to the Youth:

Email Address:

Street Address (including City and Postal Code):

Do they have any plans to move?

Yes
No

If yes, when and where are they planning to move?

Contact Number:*

When is the best time to contact them?

Other Helpful Info:

In case of emergency, whom should we contact? (Name, phone number, relationship to the youth):*

Names and Ages of Siblings of the Youth:

Are any of the siblings currently involved in a BBBS program? If, so which ones?

Do you have any involvement with the Ministry of Social Services (Child and Family Services), Keyanow, or Kanaweyimik?*

Yes
No

We ask this question to ensure that we are able to work collaboratively with others in your Circle of Support and to provide any additional resources that might be available through specific grants.

What type of involvement?

Family Enhancement
Protection

Name and Contact Info (Phone Number and Email) for Your Worker:

What is your family's cultural background?

This information is used for the purpose of calculating diversity statistics to enable Big Brothers Big Sisters of Saskatchewan to evaluate our progress to achieving a representative and diverse organization. Our goal is to have representation of the demographics of the diversity within Saskatchewan in our organization that reflects the community we serve.

Does your youth self-identify as an Aboriginal person? (This is inclusive of First Nations, Inuit, and Metis)

Yes
No

If yes, please indicate:

First Nation
Inuit
Metis

If First Nations, please share with us which First Nation:

Parent/Guardian Languages Spoken:

Youth Languages Spoken:

Do you need an interpreter?

Yes
No

Is your youth a Canadian Citizen?

Yes
No

Is your youth a Canadian Citizen?

Yes
No

If 'No', what country were they born in?

Are you a Newcomer?

Yes
No

If 'Yes', please check one:

Permanent Resident under 3 years
Permanent Resident over 3 year
UNHCR Refugee
Refugee Claimant
Temporary Foreign Worker
Work Visa

Immigration Number/Permanent Resident Card #:

This information is collected and shared with funding bodies as part of our agreement with provincial and federal funding sources.

Getting to Know Your Youth:

This information helps us begin to understand your youth, which will help us find them a good mentor.

What do you hope to gain by having mentorship in your youth's life?

Does your youth have any specific medical conditions, allergies, mental health diagnosis, or other concerns we should know about? If yes, please describe:

What other programs, services, or resources does your youth or family participate in? (please include any support workers linked with your family, youth workers, community programs, etc).

Any other comments or helpful information you'd like to share:

Parent or Guardian Signature

Date

Email

This field is for validation purposes and should be left unchanged.