2022/2023 Student  Academic Coaching Request Form!
Thank you so much for your interest in connecting your student with a parent or community member volunteer to help with virtual academic coaching at O.Henry Middle School! This form will help us gather information about your student and the coaching times that work best for you and your family. Once we receive this form, we will send along an additional form to sign agreeing to the parameters of the program. We will then work to find a volunteer available during your preferred times and introduce you to the volunteer via email. Details from this survey will be shared with the volunteer coordinator and the volunteers selected to work with your student. The volunteer will help set up the initial Zoom session and all communication will be between the volunteer and the student's parent or guardian. Ideally volunteers will meet 1 to 2x per week with your student for 30-60 minute sessions.

Please see the attached FAQ for more information, and if you have any questions, please reach out to program coordinator at kcotter1815@gmail.com. Information from this form may be shared with other program volunteers. Thank you for your support!


To translate into another language, right click on the form and select “translate to” and use options to select the language

Para traducir a otro idioma, haga clic con el botón derecho en el formulario y seleccione "traducir a" y utilice las opciones para seleccionar el idioma
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Please provide the full name of the parent or guardian contact:
Please provide the email contact for the parent or guardian:
Please provide the  phone number for the parent or guardian
Please share the student's first name:
Please share the student's current grade level:
How did you hear about the program?
Each virtual session will be conducted over Zoom and will require that the student have full access to their AISD Portal, Google Drive & Blend. Students will screen share with their volunteer during each session. Please indicate if there are any issues with accessing these platforms currently:
Have Access
Do Not Have Access
AISD Portal
Google Drive
What type of computer is your student currently using?
Clear selection
If there is a language other than English that you as a parent or guardian prefer or that your student would prefer, please let us know below:
Please tell us what times (afternoon or evening on weeknights or morning, afternoon or evenings on weekends)  and days of the week or weekend work best for your family. Ideally we would like a parent or guardian nearby during the sessions in case a question comes up about technology, reaching out to a teacher, etc., but this is not required.
Tell us more about your student. We would love to know more about them, their hobbies, interests, and anything you would like to share that can help us best support them!
We hope to share data with O. Henry administration on program participation, please let us know if you are comfortable with us sharing your student's name with O.Henry staff for tracking purposes?
Are there specific areas of support that you would like the volunteer to focus on (check all that apply)
Do you think Assistive Technology Tools like the ones listed below could be a benefit to your child and do you approve adding these free tools to your child's Chrome extension if possible? Check all that apply:
Please tell us more about your goals for the program. What is most important for you and your child in getting meaningful academic support?
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