Please ensure all required fields are completed in order to submit the application
If there is an error or missing information you will not be able to submit the form.
Errors will be identified by red text or asterix.
 
 
Contact Information
 
 
 
Which program are you most interested in?*
 
 
How did you hear about us?
 
 
 
Chosen Name
 
 
First Name
 
 
Last Name
 
 
Middle Name
 
 
Other Names
 
 
Pronoun
 
 
E-mail
 
 
Alternate E-Mail
 
 
 
Home Phone (Land Line)
 
 
Mobile Phone
 
 
Business Phone
 
 
Street Address
 
 
City
 
 
Postal Code
 
 
PO Box or RR #
 
 
 
 
Preferred Form of Contact
 
 
Preferred Day to contact
 
 
Prefered Time Of Contact
 
 
Preferred Language of Communication
 
 
 
 
 
Demographic Information
 
 
 
Date of Birth (mm/dd/yyyy)
 
 
Gender Identity
 
 
Marital Status
 
 
 
If Not Represented, you may identify:
 
 
Partner/Spouse Name
 
 
Do you live with others (excluding immediate family)?
 
 
Do you have children?
 
 
If you have dependants, what are their ages?
 
 
 
Additional Instructions for applicants?
  
Ethnic Identity
 
 
 
 
Born in Canada
 
Yes
No
 
Date of Arrival in Canada (mm/dd/yyyy)
 
 
Newcomer Status
 
 
Additional Languages Spoken
 
 
 
 
 
Emergency Contact Information
Emergency Contact Name
 
 
 
Relationship to Emergency Contact
 
 
Emergency Phone 1
 
 
Emergency Phone 2
 
 
 
Any comments on your health that we should be aware of? (ie: allergies)
 
 
 
 
 
Employment, Education, & Experience
 
 
 
Employer
 
 
Job / Position Title
 
 
Highest Level Of Education Completed
 
 
Are you currently attending school?
 
Yes
No
 
Name of School/Institution
 
 
Course or area of study.
 
 
 
 
 
Have you ever volunteered or worked with a child/youth serving program or organization?
 
 
 
Name of Organization
 
 
If you have volunteered/worked wtih a child/youth serving organization, may we contact them?
 
 
 
 
Have you previously applied to or been involved with Big Brothers Big Sisters
 
 
 
 
 
Transportation
 
 
 
I have regular access to a vehicle that I intend to use to participate in programs with the agency.
 
 
Does your car have passenger-side airbags?
 
 
 
 
 
Drivers License #
 
 
 
 
 
Availability

When are you most available to volunteer? 
Weekends
 
 
 
Weekday Evenings
 
 
During the School Day
 
 
 
After School
 
 
 
 
 
Other comments or information about your availability?
 
 
 
 
 
Hobbies, Interests, & Matching Information

Which of the following types of interests or activities would be relevant for you?
 
Animals
 
 
Arts & Crafts
 
 
Building (Lego)
 
 
Board Games / Cards
 
 
Computers
 
 
Cooking
 
 
Cultural Activities
 
 
Dance
 
 
Educational Activities
 
 
Festivals and Local Events
 
 
Indoor Activities
 
 
Music
 
 
Outdoor Activities
 
 
Reading / Books
 
 
Sports
 
 
Talking
 
 
Video Games
 
 
 


Would you be comfortable with the following personality traits in a child/youth you are matched with?  (Check if yes)
 
Highly Active
 
 
Outgoing
 
 
Quiet
 
 
Helpful
 
 
Withdrawn
 
 
Friendly
 
 
 
Shy
 
 
 
Gender Preference
 
 
 
 

Other considerations. 
 
 
 
 
 
Do you have pets?
 
Yes
No
 
 
Are you comfortable around animals?
 
Yes
No
 
 
 
 
What is your exposure to smoking?
 
 
Would you be willing to be matched with a child in a smoking environment?
 
 
 
 
 
 
Is there a firearm in your home?
 
Yes
No
 
Do you have a preference regarding firearms in the home?
 
 
 
 
 
 
Is there anything else you would like us to consider? Other interests you would like to share with a child or youth?
 
 
Are you anticipating any major life changes in the next year?
 
 
 
Big Supporters
A minimum of three Big Supporters (i.e. references) are required for all applicants.

Please read the instructions on each Big Supporter section carefully. 

Big Supporters - Personal should have known you at least 2 years.  
 
 
Big Supporter - Employer or Volunteer:

If you have worked or volunteered with a vulnerable population (children, youth, seniors, or persons with a disability) in the last 5 years we will require a Big Supporter of a supervisory nature from that organization. 

If you have never worked or volunteered in such a capacity, you may provide a Big Supporter - Employer of a supervisory nature. 

If you have not been employed, a Big Supporter volunteer experience  is acceptable. 

If you have never worked or volunteered, you may provide a Big Supporter - educational.

A co-worker as a Big Supporter - Employer will not be accepted. 
Big Supporter - Employer Name
 
 
Big Supporter - Employer Email
 
 
How long have you known this Big Supporter?
 
 
 
Big Supporter - Employer Mobile Phone
 
 
Big Supporter - Employer Work Phone
 
 
 
OR
 
 
Big Supporter - Volunteer Name
 
 
Big Supporter - Volunteer Email
 
 
How long have you known this Big Supporter?
 
 
Big Supporter - Volunteer Home Phone
 
 
Big Supporter - Volunteer Mobile Phone
 
 
Big Supporter - Volunteer Work Phone
 
 
 
Big Supporter - Significant Other

If you are not currently in a relationship, you should provide a Big Supporter - Family.  
 
Big Supporter - Significant Other Name
 
 
Big Supporter - Significant Other Email
 
 
Length of relationship with significant other.
 
 
Big Supporter - Significant Other Home Phone
 
 
Big Supporter - Significant Other Mobile Phone
 
 
Big Supporter - Significant Other Work Phone
 
 
 
OR
 
 
Big Supporter - Family Name
 
 
Big Supporter - Family Email
 
 
How long have you known this person?
 
 
Big Supporter - Family Home Phone
 
 
Big Supporter - Family Mobile Phone
 
 
Big Supporter - Family Work Phone
 
 
 
Big Supporter - Personal:

 
 
Big Supporter - Personal Name
 
 
Big Supporter - Personal Email
 
 
How long have you known this person?
 
 
Big Supporter - Personal Home Phone
 
 
Big Supporter - Personal Mobile Phone
 
 
Big Supporter - Personal Work Phone
 
 
 
 
 
 
Is there anything else about yourself or your application that you'd like to share?
 
 
 
 
 
APPLICATION DECLARATION 
By clicking this box I understand and agree to the terms of the application as referenced above.*
 
I Agree
 
 
 
 
 
 
Please Pick Todays Date*
 
 
 


Office Use 
 
 
Application Received On-Line
 
 
Prince Albert Agency Name
 
 
Application Received
 
 
Volunteer
 
 
 
 
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