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Heart of Iowa BBBS

Heart of Iowa BBBS Volunteer Application

Non-Discrimination Policy

Our participants come to us with a wide range of personal characteristics. We believe that participant eligibility shall be determined without regard to race, color, religion, national origin, gender, marital status, sexual orientation, gender identity, veteran status, or disability. 

Basic Information








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Contact Information


























Employer Information











Additional Information

NOTE for BBBS staff (delete before making the form live): You will need to update the drop down above with the corresponding options for your chapter. Once you've added the locations available to your chapter, go into the Update Contact step in the submit connector and update the Agency Location mappings, using record IDs of the Agency Locations IDs as the send-as values 








References and Background Check

Previous Experience










Volunteer Experience











Please provide at least three references below including:
  • Your spouse or domestic partner OR a family member if you do not have a spouse, partner, or significant other.
  • Current or former employee or co-worker you have known for at least one year or someone from your school if you are a student
  • A friend or neighbor you have known for at least two years
Spousal/Familial Reference







Professional Reference







Minimum 1 year
Personal Reference







Minimum 2 years
I consent to and understand that:
  1. The references and youth-serving organization(s) I listed may be contacted by mail, telephone, email, or in person;
  2. The information I provided may be used to conduct a background check, to include a search of public domain records, driving records check, juvenile and adult criminal history check (see attached authorization), military records, and other records where required by local, state, or federal law for volunteers working with youth;
  3. I am in no way obligated to perform any volunteer services;
  4. The BBBS agency is not obligated to match me with a youth and may deny my application or close my match at any time, and to protect all participants’ confidentiality, BBBS is not required to disclose reasons for doing so; 
  5. Other BBBS agencies and youth organizations where I have worked or volunteered may be contacted as references;
  6. As part of the enrollment processes, I will be required to provide additional personal information, including completion of an in-person interview;
  7. I understand that the information I provide in the enrollment process will be kept confidential, unless disclosure is required by law.  
  8. I understand that detailed accounts of child abuse or neglect, past or present, will be reported to proper authorities;
  9. I understand that certain relevant information about me will be discussed with the parent/guardian of a child who is a prospective match (this might include demographic information, information relevant to parent/child preferences, and any information relevant to a child’s safety or well-being);  
  10. It is my responsibility to update the agency if any of the information I provide on this application, in my interview, or any other information provided during the enrollment process changes (i.e. address, phone number, auto-insurance, new criminal charges, etc.)
  11. I agree to complete questionnaires throughout my time in the program to evaluate and improve program services;
  12. I agree to timely communication and follow-up with all agency staff as required by the agency.

Pre-Interview Questionnaire

Prior to your in-person interview, please answer the questions below. The information you provide will also help us make a better match for you and assure we can support you during your involvement with our program. Please note that you will have an opportunity to discuss these questions and your responses more thoroughly during your in-person interview.  





Agency Weapons Policy

The agency inquires with all potential participants about their personal use and ownership of firearms during the enrollment process. If at any time, during the life of the match, a volunteer becomes an owner of firearms or weapons, firearms or ammunition ownership are licensed, permitted, registered, and handled in accordance with all applicable state and federal laws. Volunteers must secure and lock weapons and ammunition in order to be approved and matched with a Little. If a volunteer discloses ownership of any , this information must be shared with the child's parent/guardian. A Weapons Policy must be signed by the volunteer. 


Volunteers are responsible for ensuring that all weapons, firearms and ammunition are made inaccessible at all times to their Little throughout the life of the match. The volunteer must seek parental approval and notify their Match Support Specialist prior to using a firearm on a match activity such as target-shooting or hunting. In order to use firearms, volunteers and children must follow all Iowa laws including age restrictions and required gun safety certification.


Additionally, all children matched in the program should refrain from taking weapons, including pocket knives, with them during match outings. 







Please provide the name, age, and relationship to you for anyone else residing in your home.


Release of Information Authorization for Background Check

It is the policy of Heart of Iowa Big Brothers Big Sisters to conduct criminal background checks to screen volunteer applicants, board members, agency staff, and non-mentoring volunteers who come into meaningful contact with children. Agency background checks include verification of the volunteer's social security number and residential history with the past five years. The screening process consists of the following:

All staff, board members, and mentors require a layered criminal history check, meaning that criminal history checks are completed at the local, state, and national levels, and include:
  • Proof of identification (ie: valid driver's license)
  • Social Security Number Verification
  • Local Police
  • Local sex offender registry
  • Iowa Courts Online
  • Iowa Department of Transportation (DOT)
  • Iowa Department of Criminal Investigation (DCI) (For 18+ year olds)
  • National sex offender registry
  • National Criminal History
  • Child Abuse Registry - DHS
In addition, the following background checks will be completed on anyone in the Community-based volunteer's home age 18+ requiring the full name and date of birth:
  • National Sex Offender registry
  • Iowa Courts Online
International checks through the layered background screening database should be completed for any volunteer applicant who has resided outside the United States within the last two years, at time of application. An exception may be made if the time period of international stay was less than 6 months (example: with a study abroad program). 

If the candidate has been in active military, military service checks must also be completed because military court records are separate from public court records. This includes:
  • If Active Military, a memo from their Security Manager should be gained, verifying that they have clearance or in good standing. 
  • If Veteran, a copy of the DD214 is required, demonstrating the character of their discharge. Only Honorable Discharge will be accepted as a volunteer. 
** March 28th, 2016, Angie Scott from BBBSA confirmed NCIC checks do not need to be completed as agencies do not have access to them. 

Criminal background checks are updated on a three-year cycle, prompted through Matchforce, and include:
  • Iowa Courts Online
  • Child Abuse Registry - DHS
  • First Advantage 
  • Iowa DOT
A staff member will conduct all background check searches and give to the designated staff member to review. That designated staff member will review and sign off on the background checks and return to Customer Relations Specialist. The staff will then select the appropriate evaluation choice in Matchforce and file paperwork appropriately. 

Confidentiality and Digital Platform Policies

Children's safety is a top priority of the agency. In order to help ensure child safety, the agency performs thorough professional screening of all participants before approving them for participation. Once participants are approved and matched, they receive ongoing match support. In addition to other ground rules and guidelines for participating, specific safety policies and procedures are in place in order to protect youth, as well as adults. Violation of any of these policies may result in actions up to and including termination of the match and of the participant from the program. Decisions will be determined based on the severity of the incident and the level at which their actions presented harm to themselves or others. 


Heart of Iowa Big Brothers Big Sisters recognizes that online social networking (Facebook, Twitter, Snap Chat, Instagram, etc.) is an incredibly popular communications tool and that many of our Big Brothers/Sisters, Little Brothers/Sisters, parents/guardians and agency staff use these websites. It is our recommendation that Bigs and Littles/parent/guardians not be friends or communicate through social media. Any posting of photos online by Bigs/staff of Little will require approval by parent/guardian and will not include the name of the child to insure confidentiality, privacy and child safety.

Virtual Platform


Media Consent and Release

I irrevocably consent to any and all uses and displays of my name, image, likeness, appearance, basic biographical information, audio/video recordings, writings, artwork, and the like, in original form or in modified form, in whole or in part, in, on, or in connection with merchandise, advertising, publicity, marketing, fundraising, and the like, in printed or electronic media, of any type, throughout the world at any time by Big Brothers Big Sisters of America and [BBBSA affiliate] in their sole discretion, and by any of their affiliates, successors, partners, sponsors, donors, any entities or persons with whom they conduct any public relations, marketing, or fund raising of any type, and any other authorized third parties, without further consent from me, without any royalty, payment, or other compensation to me, and with the release and waiver of any claims, actions, damages, losses, costs, expenses and liability of any kind arising from any such use (the “Released Material”).
In consideration of the mutual promises made herein, and for other good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I hereby grant to BBBSA and its affiliates the right to use the Released Material as BBBSA and/or its affiliates may desire, in all media now existing or hereafter created and in all variations and forms including, but not limited to, internal or external publications or productions, informational or recruitment materials, marketing materials, fundraising materials, televised photography and/or recordings, advertisements, Public Service Announcements, and/or online and social media sites. The use of this information shall be at the sole discretion of BBBSA and/or its affiliates.

I further grant to BBBSA and its affiliates the absolute right to use the Released Material in whole or in part, alone or in conjunction with any other image, name, writings or reproduction, in color or otherwise, for art, advertising, business, trade, or any other lawful purpose whatsoever, in perpetuity throughout the world.

I understand and agree that all materials created by BBBSA and/or its affiliates that use the Released Materials are the property of and are owned by BBBSA, and that I cannot authorize their use by any other party.  I further understand that BBBSA may authorize their use by a third party. I hereby irrevocably transfer and assign to BBBSA my entire right, title and interest, if any, in and to the Released Materials and all copyrights in the Released Materials arising in any jurisdiction throughout the world, including the right to register and sue to enforce such copyrights against infringers.

I acknowledge and agree that I have no right to review or approve the Released Materials before they are used by BBBSA and/or its affiliates, and that BBBSA has no liability to me for any editing or alteration of the Released Materials or for any distortion or other effects resulting from BBBSA’s and/or its affiliates’ editing, alteration or use of the Released Materials.  BBBSA has no obligation to use the Released Materials or to exercise any rights given by this Consent and Release Form.

I hereby release BBBSA and its affiliates, employees, and agents, as well as any partner companies, from all claims, demands or liabilities and related financial costs that I may now or hereafter have arising in connection with BBBSA’s exercise of the rights hereby granted, and/or with the appearance or the Released Materials in any publication or production. These include, without limitation, claims for compensation, defamation, or invasion of privacy, or other infringements or violations of personal or property rights of any sort whatsoever.

Child Safety Guidelines and Ground Rules for Volunteers                                                                      

Children's safety is a top priority of the agency. In order to help ensure child safety, the agency performs thorough professional screening of all participants before approving them for participation. Once participants are approved and matched, they receive ongoing match support. In addition to other ground rules 

Application Acknowledgement

I understand that this is an application for a volunteer opportunity and is not a promise or commitment by Big Brothers Big Sisters.

I certify that all information I have provided or will provide to Big Brothers Big Sisters, including this application, is true, accurate, and complete to the best of my knowledge. I certify that I have and will answer all questions to the best of my ability and that I have not and will not withhold any information that would affect my application for a volunteer position. I understand that information contained in my application will be verified by Big Brothers Big Sisters. I understand that misrepresentations or omissions may be cause for my immediate rejection as an applicant or my termination as a volunteer.

At any time while involved with the Big Brothers Big Sisters program, I agree to immediately inform my Big Brothers Big Sisters contact person of any and all infractions, violations, charges, and convictions related to any civil, domestic, or criminal matters.  I understand that BBBS staff needs to be fully informed to provide the best guidance or support possible.  

Contact Information