Big Brothers/ Big Sisters of Loyola University New Orleans Application

Are you a new or returning mentor? New applicant Returning mentor

First Name
Last name
Email Address
Local Phone Cell Phone Holiday/Permanent Phone

School
Today's Date

Gender Male Female
DOB (MM/DD/YYYY)
University Status
Students only: Expected Graduation date
Ethnic Background (Voluntary - will be used in a nondiscriminatory manner, consistent with applicable civil rights laws):

African-American/Black (non-Hispanic)

Caucasian-American/White (non-Hispanic)

Hispanic/Latino (including Puerto Rico)

Native American/Alaskan Native

Other (please enter)

Campus Address

Permanent Address

Emergency Contact Person and Phone Number

References:

1. Name Phone Number

2. Name Phone Number

I hereby give permission to Big Brothers/ Big Sisters of South East LA to call the references given above to determine whether I would be a suitable mentor in the Big Brothers/Big Sisters program and to screen me for criminal offenses. I understand that completing this application does not guarantee I will be accepted into the program. I understand that not every volunteer accessing the Big Brothers/ Big Sisters program is accepted and that reasons for non-acceptance are never disclosed.

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