Parent Consent Form: APIE Mentor Program 2024-25

Dear Parent or Guardian,

Your student has been selected to participate in the Austin Partners in Education’s (APIE) mentoring program supported by AISD. With your approval, a screened and trained mentor will visit your child at school, during the school day, once a week for approximately 30 – 60 minutes. Mentors provide individualized social, emotional, and academic support to help students become college and career-ready by graduation.

Any communication that takes place outside of school is strictly at the discretion of the parent. AISD and APIE will take no responsibility for interactions outside of school property.

To evaluate the program’s success, APIE may collect academic achievement grades, test scores, discipline referral data, and attendance records. At the end of the year, students may be asked to complete a brief survey about their experience. This student data will be summarized in a final evaluation for program improvement and will be communicated to key program supporters.

Note: This data will not be used to evaluate or assess individual students. Information will be communicated in summary and student privacy will be protected per AISD guidelines.

If you consent to your child’s participation in this program, please sign below.

Student Name*

Name of School*

Student AISD ID number

Name of Parent/Guardian*

First NameLast Name

Parent/Guardian Email*

Parent/Guardian Phone Number*

There are a few optional permissions.

To evaluate the program’s success, APIE may collect grades, test scores, discipline referral data, and attendance records. At the end of the year, students may be asked to complete a brief survey about their experience. This student data will be summarized in a final evaluation for program improvement and will be communicated to key program supporters.

Note: This data will not be used to evaluate or assess individual students. Student privacy will be protected per AISD guidelines.

To ensure a healthy and supportive mentorship experience, the school may want to share some background information about your child with their mentor. However, this will only be shared if you provide consent by checking the first box below.

Please check any or all boxes that you give your consent:

I consent to the school sharing information about my child with their mentor. For example, if your student is struggling academically or is having behavioral issues in class, the school can share this information with your child’s mentor so that they can provide more effective support.I consent to AISD releasing student data to APIE for program management, evaluation, and reporting.My child may be photographed or videotaped and those images may be used in publicmedia (print, TV, newspaper) for information or promotional purposes.

Signature*

If you have questions, please contact your child’s campus Mentor Coordinator or the APIE School Connections Manager, Wen Nguyen, at wnguyen@austinpartners.org or 512-637-0983. Thank you!

Date*

Date

Parent/Guardian Consent Form