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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 disabilities or limitations? If yes, please explain.
Has the child ever been involved with legal authorities? If yes, please explain.
What social, academic, or personal concerns does the child show in school and/or with peers?
In general, describe the child's personality. Include strengths and struggles.
If known to you, describe the parent-child relationship, including any areas of conflict:
How do you feel that the parent/guardian will partner with Big Brothers Big Sisters and the child's assigned mentor? Any concerns?
In what specific ways do you think a Big Brother/Big Sister could assist the child?
Are there any behaviors/attitudes/coping mechanisms/etc. that might present a challenge in a match relationship?
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