Dream Bigger Mentoring Program Enrollment Form (2021-22)
By completing this form you are authorizing your student to participate in the Coalition of Black Men's mentoring program: Dream Bigger offered within Portland Public Schools.

As a Parent / Guardian / Surrogate Parent / Foster Parent / or Adult Student, I authorize the release and exchange of confidential information between Portland Public Schools, Coalition of Black Men and their evaluators.

This information may include:
Student name & student ID#
Demographic information (such as race, gender, grade)
Discipline data

The disclosure is to be used for the following purposes:
To support students' educational needs
To support students' school attendance
Program evaluation

We are limited to a capacity of 15 students per school:
Astor Elementary School: 8 spaces remaining
Harriet Tubman Middle School: 9 spaces remaining
Ockley Green Middle School: 7 spaces remaining
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This form was created inside of Coalition of Black Men.