Your Information
Your Name
Your local (campus) address
Your Permanent
Address
(Apt
or Suite if applicable)
City/Town
ZIP
Your Local Phone
Your Home Phone
Your Email Address
Date of birth
Field of Study
(Dept)
Grad/Undergrad
First degree
sought &
Expected date
,
Ultimate degree
sought & Expected date
,
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)
Do you
have any children currently living with you? Please specify name
and date of birth (mm/dd/yyyy)
1.
2.
3.
4.
5.
Please list two individuals who could serve as references for you, with
their email address and/or phone number:
1. Name:
Contact info:
2. Name:
Contact info:
MAKING A CONNECTION...
State
briefly your interest in being a Big Sibling and what you have to offer
an adoptive family:
Do you
have a preference for being a Big Sibling for a: (check
all you're happy to be considered for)
Sex
Male
Female
Age range
0-3 year old
3-6 year old
6-10 year old
10-14 year old
14-18 year old
In considering the question of age,
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.
Number
Single child
Sibling Group
maximum #
Do you prefer a child of any specific nationality or ethnicity?
If so, please list your preferences
in order (if not, please leave blank):
1.
2.
3.
4.
Your 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?
Do you have a car or will you be relying on public transportation?
Are you a smoker/non-smoker?
What
are your special interests, e.g. music, sports,
theater, travel?
To assist
our efforts to find the right little sibling for you, is there anything
else you'd like to tell us about yourself?
How did you learn of the Big Sibling Program?