The Black Youth Mentoring Program is for individuals who identify as being part of the Black community.
Black mentees will be supported by Black mentors.  This program explores pathways to education, as well elements related to Blackness and Black culture.

Black Youth Mentoring Registration Form

  • Thank you for your interest in Black Youth Mentoring. Once your submission has been reviewed by our team, you will receive an email confirmation with more details about the program.

  • PERSONAL INFORMATION

  • MM slash DD slash YYYY
  • This response is voluntary and will be used for statistical purposes only.
  • This response is voluntary and will be used for statistical purposes only.
  • EMERGENCY/ALTERNATE CONTACT

  • Please provide an alternate contact to call in case of emergency.
  • ADDITIONAL INFORMATION

  • We realize that this information can be of a sensitive nature and it will be treated with confidence and respect.
  • Ex. religious or cultural views, stressors, other existing issues?
  • PROGRAM SITE

  • Please note that guardians are responsible for pick-up and drop off.
  • Media Consent

  • Please select your response to the Media Consent statement listed above.
  • Informed Consent

  • I have read and understand this agreement. By checking YES, I acknowledge that I am the parent/guardian of the child for whom I am applying and that I hereby request Big Brothers Big Sisters service for my child. I give my child permission to participate in one or more group programs offered by BBBSP. I am aware of and understand the risks, dangers and hazards associated with the above service and agree such service is suitable for my child.
  • Parent/Guardian Signature