Young Person Referral Enquiry · Customer Self-Service

Big Brothers Big Sisters Australia mentoring programs are currently receiving a large amount of enquiries. The processing of new volunteer mentors and young person referral enquiries for some programs may be delayed quite significantly. We apologise for any inconvenience this may cause. If you would still like to be contacted if a suitable opportunity arises please complete an enquiry form from the program box below.

Enquiry Type

Program

Email Address of Parent/Guardian or Young Person Mentee

**

Does the Young Person Mentee have access to a device that provides a secure and adequate internet connection?

Young Person Mentee's Details

Title

First Name

*

Last Name

*

Gender

Gender (please describe if you would like to)

*

Date of Birth (DD/MM/YYYY)

*

Suburb

*

State

Postcode

*

Referrer’s Details – Please complete the relevant section if you are a parent/guardian, professional working with the Young Person Mentee, or other person completing this enquiry.

Full name of parent/guardian

*

Parent/Guardian mobile phone

*

Parent/Guardian home phone

*

Full name of person making referral (if not parent/guardian)

*

Agency

*

Referrer Email

**

Phone of person making referral

*

Please provide a brief reason for referral enquiry

*

Collection Statement
Big Brothers Big Sisters Australia (BBBSA) collects the information provided on this form for the purpose of assessing the Young Person Mentee’s application and determining how we can best help your child. For further information please refer to our Privacy Policy, which is available by clicking on the below link and contains further details about the personal information we collect, how it is collected, what is done with it, who it is shared with, where it is sent and your information access, correction and complaint rights. If you have any queries please contact support@bbbsau.org or call 1300 463 686.
Big Brother Big Sister Privacy Policy 2018

Authorisation and Declaration
I declare that the information I have provided in this young person mentee's Referral Enquiry Form is true and correct. I agree, as a condition of my child’s engagement with BBBSA, that:

In relation to my child’s application, BBBSA may collect personal and sensitive information as part of the application process and, from time to time, during his or her engagement with BBBSA.

I am required to inform BBBSA of any changes to mine or my child’s circumstances during his or her involvement in the program;

All personal and sensitive information collected by BBBSA as part of the application process is for the purpose of determining whether the young person mentee is suitable to join the program and to enable BBBSA to retain appropriate information to deal with any future legal liability which may arise in relation to the child’s engagement with BBBSA;

Any agencies, individuals or other entities such as (but not limited to) educational institutions, law enforcement agencies, social services, other BBBSA agencies and other such entities with which my child has had contact, may release any information about, or relating to, him or her as requested by BBBSA which may be relevant to their involvement with BBBSA;

If my child’s application is successful, BBBSA will retain his or her personal information for the duration of their engagement as a mentee and for the life of the file, which may be up to 100 years. If my child’s application is unsuccessful, BBBSA will securely dispose of all personal and sensitive information relating to my child’s application after 12 months, unless required for legal reasons.

Collection and retention of my child’s personal information is required as a condition of his or her engagement with BBBSA and BBBSA may refuse the application or terminate my child’s engagement with the program if my consent is not provided;

A photocopy of this authorisation is sufficient evidence of my consent to the release of any information about, or relating to, my child to BBBSA.

Unless I contact BBBSA to request otherwise, my child’s personal information will be included in the BBBSA young person mentee database hosted in Australia. I acknowledge that while BBBSA has taken steps to protect this personal information, BBBSA will not be accountable for overseas recipients under the Privacy Act and that I may not be able to seek redress under the Privacy Act.

Where I provide personal information about other people, I must ensure that those people are aware of and agree that this information is being collected and used by BBBSA for its functions and activities, and they can see the BBBSA Privacy Policy (as described above) for further details.

I have legal authority to represent the young person mantee referred to above.

If I am not the parent/guardian to the young person mentee referred to above I have received consent from the parent/guardian to submit the online referral enquiry on their behalf and they are aware and agree to their child's details being added to the BBBSA Young Person Mentee database hosted in Australia.

Full name of person making referral

*

Created On

By clicking ‘submit’ I agree to the terms above, including the Authorisation and Declaration.