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Little Application Form

Who is a Little?
A Little is a school aged child who is in need of friendship and or emotional relationship to help develop his or her interpersonal skills, to improve their academic performance, to have a greater feeling of self confidence, and to gain trust or a sense of belonging.

To Enroll a Child  Please Fill out the Form Below:

 

Application Date (YYYY-MM-DD)

Name of Child:
Name of Parent(s) Guardian(s):
Address:
Phone Number (Home):
Work:
May we call you at work:
Children's Age:
Religion:
What are the best days and times for your child to meet with his/her Big Brother/Sister?
What are some of your child's Interest and hobbies?
What do you expect from your child's mentor?
Would you prefer a male or female Mentor? (This does not guarantee you will have your choice)
Will you be available to attend an orientation training session with your child upon the formal request of the Social Development Department?
Please list someone to be used as an alternate contact if you cannot be reached.
Name:
Relationship to you:
Address:
Phone Number (Home):
Work:
Cell:
Submit
* Required
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