Your Information
Your Name
Your local address
City/Town
ZIP
Your Occupation
Your Work Phone
Your Home Phone
Your Email Address
Spouse or Partner's
Information (if applicable)
Name of Spouse or
Partner
Spouse or Partner's
Occupation
Spouse or Partner's
Local Phone (if different)
Email Address of
Spouse or Partner (if applicable)
How many
children are currently living with you? Please specify name
and date of birth (mm/dd/yyyy)
1.
2.
3.
4.
5.
Please Note: Big sibling relationships
provide not only a cultural connection for an adopted child, but also an
opportunity for the adoptee's family to learn more about the adoptee's culture
of origin and to become more racially aware. It is to be expected that
children age four and older are more likely themselves to benefit directly
from the contact with a big sibling, whereas in cases where the adoptee is
under four, the primary benefit will accrue to other family members.
Of course, should the big sibling connection continue for several years,
the nature of the relationships will undoubtably change.
Families should keep in mind that it may take a bit longer to find a big
sibling for a very young child.
For which child
or children (listed above) are you looking for a Big Sibling?
1.
2.
3.
4.
5.
Please list two individuals who could serve as references for you and your
family, with their email address and/or phone number:
1. Name:
Contact info:
2. Name:
Contact info:
MAKING A CONNECTION...
State briefly your interest
in having a Big Sibling and any information about your family that might
be relevant to making a good connection:
Do you
prefer a Big Sibling who is: (check all that you'd
consider)
Sex
Male
Female
Age range/student status
undergraduate (usually ages 17-21)
graduate student (usually ages 21-30)
Do you prefer a Big Sibling of any specific nationality
or ethnicity? If so, please list your preferences
in order (if not, please leave blank):
1.
2.
3.
4.
Your child/children's
race, ethnicity, country of origin (OPTIONAL):
Notes/Comments:
What days/times are you most likely to be available?
Are you available on weekends? MIT holidays?
Will you be able to provide transportation for your child/children's
Big Sibling to/from MIT?
What
are your family's special interests, e.g. music,
sports, theater, travel?
To assist our efforts to find the right Big Sibling for you,
is there anything else you'd like to tell us about your family?
How did you learn of the Big Sibling
Program?