Study Buddy Application Form

The Study Buddy Program matches students in Grades 2 to 8 with a Teen or Adult Mentor. It is a one-to-one mentoring relationship that focuses on schoolwork and building connections through a once-a-week tutoring session. Matches will spend 1 hour per week together, virtually or at the Mentee's school, where the Mentor will help the Mentee with their schoolwork or related skills they want to build upon and practice.

Pronouns

Name(Required)

First Last

Home Phone(Required)

Cell Phone

Can we call you at work?

Yes

No

Work Phone

Email(Required)

Enter Email Confirm Email

Alternate Email

Preferred method of contact:(Required)

Current Address(Required)

Street Address Address Line 2 City Postal Code

Date of Birth(Required)

MM

DD

YYYY

Age

Gender Identity

Male

Female

Other

Were you born in Canada?(Required)

Yes

No

First Language(Required)

English

French

Other languages (incl. sign language)

Emergency Contact Information

Please provide information for a close friend or family member we may contact in the event of an emergency.

Emergency Contact Name(Required)

Relationship to you(Required)

Emergency Contact Phone(Required)

Emergency Contact Alternate Phone

Other Information

How did you hear about Big Brothers Big Sisters?(Required)

Marital Status(Required)

Do you have children?(Required)

Yes

No

How long have you been a resident of the Lower Mainland?(Required)

More than 6 months

Less than 6 months

Question Section

What qualities do you feel you have to offer a mentee in a tutoring relationship?(Required)

Please comment on your past and present health (physical, emotional, and mental).(Required)

Describe the experiences you have had with people of different cultures, religions, and sexual orientations.(Required)

What are your beliefs about children/childhood?(Required)

The required time commitment for the Study Buddy Program is 1 hour each week for 6 months. Do you feel you can easily manage this with your schedule and future plans?(Required)

Yes

No

Unsure

Do you anticipate any change in residence, education, employment, health, or domestic status in the next year?(Required)

Yes

No

If yes, please explain.

VOLUNTEER PERMISSION AND RELEASE AGREEMENT

TO: [BIG BROTHERS BIG SISTERS OF CENTRAL AND SOUTHERN INTERIOR OF BC] (THE “AGENCY”)

The Agency and Big Brothers Big Sisters Canada (“BBBSC”) are separate entities and this Agreement is between me and the Agency.

1. By applying to volunteer with the Agency (“Volunteer Application”) and signing this Agreement, I acknowledge, understand and accept that:

I am a legal resident of Canada and have reached the age of majority in the province or territory in which I reside. I acknowledge and agree that if I have not reached the age of majority of the province or territory in which I reside, my parent or legal guardian will also need to sign this Agreement in order for my Volunteer Application to be considered;
There is no obligation on the Agency to accept my Volunteer Application or assign me as a volunteer into a mentoring program (a “Mentoring Program”) and the Agency may terminate my involvement in a Mentoring Program in its sole discretion and without reason;
If I am accepted as a volunteer, my involvement in a Mentoring Program is not intended to create and shall not be construed as creating either an employee–employer relationship or a contract for services that would allow me to receive a salary, compensation, payment or any benefits, monetary or otherwise; and
If I am accepted into a Mentoring Program, I understand that I will be required to enter into a confidentiality agreement with the Agency, and I agree to abide by the volunteer position description(s) and code(s) of conduct established by the Agency, including any applicable guidelines, Standards and policies.

2. Assumption of Risk, Release and Reimbursement. I acknowledge, understand and accept that:

I am responsible for all risks associated with my involvement in a Mentoring Program including, without limitation, the risk of bodily or psychological harm or injury.
Subject to local laws, I agree not to sue the Agency, BBBSC and/or any of their member agencies in respect of any such injury or claim resulting from my participation in a Mentoring Program, my Volunteer Application, the acceptance or denial of my Volunteer Application, the Alumni Program and/or my association with the Agency or BBBSC.
I understand that I am fully responsible for any damage to my personal vehicle and/or property during my volunteer involvement in a Mentoring Program and that neither BBBSC nor the Agency insures personal vehicles or property belonging to its volunteers;
I agree to reimburse the Agency and/or BBBSC and/or any of their member agencies for any damages or losses of any kind (including but not limited to the injury of any other person and/or damage to or loss of property) that may arise in connection with my gross negligence, willful misconduct, or failure to act in accordance with published BBSC policies and guidelines and relating to or arising in connection with my participation in a Mentoring Program or my association with the Agency or BBBSC, including payment of any and all legal expenses of the Agency, BBBSC and/or any of their member agencies.

3. Background Check. I understand that my acceptance into the Mentoring Program will be conditional on my successful completion of a background check, which may include contacting the references included in my Volunteer Application and/or a criminal record check, for the purposes of confirming my suitability for the Mentoring Program. I agree to provide all necessary consents for such background checks.

4. Privacy Notice. The personal information provided by me or otherwise collected by the Agency in connection with my application will be used by the Agency for the purpose of evaluating and considering my Volunteer Application and if accepted into a Mentoring Program, for the purpose of administering the Mentoring Program. This information may include my name, phone number, mailing address, date of birth, results of background check, and driver’s license and auto insurance information. My personal information will be maintained by the Agency on a confidential basis and will only be disclosed to the parent(s) and/or guardian(s) of a child with whom the Agency may consider “matching” me in a Mentoring Program, to representatives of a school or institution in connection with my participation in a site-based Mentoring Program, to the BBBSC as required for the purposes of accreditation reviews or legal proceedings and as otherwise required or permitted by law. In the event the Agency ceases operations, any and all information about me held by the Agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above.

In the event where it is deemed necessary, any and all information about me held by the agency will be provided to BBBSC, another BBBSC agency selected by BBBSC, or both and will be used for the purposes set out above. No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agencies, about parents, children or volunteers without their express prior written consent except where required by law.

5. Other Terms of this Agreement.

In entering into this Agreement, I am not relying on any oral or written representations other than as set forth in this Agreement.
This Agreement shall be governed by and construed pursuant to the laws of the Province or Territory in which the Agency is located.
In the event that any provision or term of this Agreement is held to be invalid, illegal or unenforceable, the remaining provisions of this Agreement shall remain in full force and effect.

Applicant's Digital Consent Signature(Required)

First Last

Date Signed(Required)

MM

DD

YYYY

Type of Study Buddy Mentee

Check one or two that apply.

Age range preference(Required)

7 or 8 years old

9 to 11 years old

Middle school (12 to 14 years old)

Other Information

Do you drive and have a car available to you?(Required)

Yes

No

How much time are you willing to travel for?

Have you ever been charged and/or convicted of a criminal offence?(Required)

Yes

No

If yes, please explain:

Is there anything else you think we should be aware of when looking for a good match for you? Is there anything you would like to discuss with the Mentoring Coordinator during your interview?

Hypothetical Scenarios

Below are three common situations that could come up during your time as a Study Buddy. Please read each one carefully and consider your comfort level with each and then respond to the questions.

Scenario #1

Your Study Buddy Mentee is regularly forgetting to bring their schoolwork to your weekly study sessions and has missed a number of sessions with you. As a result, you feel there is no progress being made in your time together.

Why do you think this may be happening?(Required)

How would you handle this situation?(Required)

Scenario #2

An unexpected opportunity has come up for you that will affect your ability to fulfill your time commitment to your Study Buddy Mentee.

How would you handle this situation?(Required)

How do you think your Mentee would feel?(Required)

Scenario #3

You have been matched with your Study Buddy Mentee for two months and you get along really well. You also have a good relationship with their teacher. After a study session, your Mentee's teacher asks if it would be possible for you to also help another child with their homework because they have noticed an increase in your Mentee's self-esteem.

How would you handle this situation?(Required)

What aspects of this situation are you comfortable with, and why?(Required)

What about this situation did you find difficult, and why?(Required)

Values and Triggers

We encourage you to take some time to identify and evaluate your personal values and corresponding triggers and then discuss them with the Mentoring Coordinator during your interview so they can take this information into consideration when matching you with a Study Buddy Mentee. Value: A standard or principle that is regarded as desirable or worthwhile. Trigger: To set off, initiate, or actuate. A stimulus that triggers a reflex. EXAMPLE: Jane values punctuality. She is always on time for work, appointments, and visits with friends and family. Jane is triggered when her co-worker walks in 15 minutes late for a meeting.

Do you have any strong values or triggers that we should know about before matching you with a child?(Required)

Confidentiality Policy

All staff and volunteers of Big Brothers Big Sisters of Central and Southern Interior of BC are required to abide by this Confidentiality Policy. Any breach of this policy will be considered grounds for termination.

Agency Service Delivery Staff will explain the confidential nature of our service to the volunteer, child and parent/guardian as early as possible in the orientation and/or screening process. At all times thereafter Service Delivery Staff will ensure the privacy of case information.

Information contained in the Casework files will not be disclosed by the Agency to any person without the written approval of said person except in the following cases:

where the safety of a child depends upon divulging this information. This could include suspicion of neglect or abuse of a child. The proper authorities will be informed when necessary. This could result in the disclosure of confidential information without written consent from the person to Big Brothers Big Sisters of Canada’s insurers and or legal counsel, as may be appropriate in connection with any legal proceeding or inquiry;
when subpoenaed by the courts;
where required by law;
during periodic agency accreditation reviews case records, including relevant personal information will be shared to authorized representatives of Big Brothers Big Sisters of Canada.

In the event that confidential information is requested to support a custody or access application, or for any court matter other than a “child protection” case, the agency will only release the information if required to do so by a Judge’s Order.

No staff member or volunteer shall use confidential information from the agency to advance any personal interest, financial or otherwise.

In accordance with Big Brothers Big Sisters of Canada’s National Standards:

No information will be provided to persons or organizations outside of Big Brothers Big Sisters of Canada, and its agents, about parents, children or volunteers without their express prior written consent except where required by law.
All information and records, including electronic records, shall be kept secure (for example, in a filing cabinet, desk, etc. under lock and key, password protected, etc.) and confidential at all times.

Case records will be accessible only to the Caseworker, Executive Director, Casework Supervisor, and in appropriate situations, other Caseworkers.

Applicant's Digital Consent Signature(Required)

First Last

Date Signed(Required)

THANK YOU!

Only those applicants that meet our requirements will be contacted for an interview. Please accept our appreciations for your interest!

Study Buddy Application Form