Breakthrough Houston (Virtual) Student Mentoring Agreement (22-23)
*Both student and parent/guardian must read and agree to the terms detailed below. The completion of this Agreement and Questionnaire will serve as the official signature for both parent/guardian and student.

This agreement outlines the expectations that Breakthrough Houston will have for all students who request and are assigned a Breakthrough Houston Mentor. Please note that Breakthrough DOES NOT REQUIRE that all students have a mentor. However, if students request and are assigned a mentor, they will be held accountable to the terms and conditions of this mentoring agreement. A failure to adhere to this agreement will result in a required meeting with the appropriate Program Director(s), and your continuance in the mentoring program will be solely left to their discretion.  

As a willing participant in the Breakthrough Houston Mentoring Program, students must commit to communicating with their assigned mentor throughout the duration of the program. Students must also attend all scheduled meetings with assigned mentors (unless otherwise excused) and respond to mentors when they reach out to the student. Mentors will attempt to contact students mainly through email, phone calls, or text messages. It is the responsibility of the student to make sure that all of the contact information that is provided to Breakthrough and to the mentor is correct.

Please note that Breakthrough will not be able to always match a student with the mentor that is best aligned with the student’s career interest. While we will try our best to find the perfect mentor match for each student, we are not always able to do so. Parent/guardians, please be advised that the only events that we ask our mentors to attend are all listed on the college bound calendar. If mentors request meeting in person with the student outside of those listed times, it will solely be left up to the parents/guardians of the student. Mentors are required to ask your permission before anything is scheduled with the students outside of the listed mentor/mentee college bound calendar dates.

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Email *
Student First Name *
Student Last Name *
Student Expected HS Graduation Year *
Student Contact Number
Parent/Guardian Full Name *
Parent/Guardian Contact Number *
What is the attribute of a mentor that is MOST important to you (ex: similar background, similar interests/career path knowledge, etc.)
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Would you like to be paired with your mentor from last year?
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