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Big Brothers Big Sisters of Greater Kansas City
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Big Brothers Big Sisters KC
Social Service Report - Confidential
Please complete within 5 days of receipt.
Social Service Report
You will be sent a copy of your responses to this form for your records.
How long has the child been receiving services from your agency?
Please indicate the nature of the service delivered, including why the child was initially referred to your agency:
Please summarize the child's progress as a client of your agency:
If the child is no longer receiving services, please indicate the reason(s) for the termination:
Has the child ever had a psychological or psychiatric evaluation?
If yes, when and where?
If you have the results, please summarize them.
Does the child have any physical problems? If yes, please explain.
Has the child ever been involved with legal authorities? If yes, please explain.
What social, academic, or personal problems does the child show in school and/or with peers?
In general, describe the child's personality. Include strengths and weaknesses.
If known, describe the parent-child relationship, including major areas of conflict:
What problems might the parent offer if a Big Brother/Big Sister is assigned to the child?
In what specific ways do you think a Big Brother/Big Sister could help the child?
What problems might the child offer if assigned to a Big Brother/Big Sister?
Authorized Digital Signature
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