Academic Mentoring Program Student Nomination
Thank you for your interest in the Academic Mentoring Program. Our goal is to connect students with a caring mentor who will support them throughout the school year. This could be by providing homework help, 1:1 tutoring, or just being there to listen and connect the student to other resources. By completing this form, you are nominating a BPS student for the program. We ask that you first discuss this opportunity with the student to gauge their interest. Please note, priority is given to students in grades 6-12 or who are transitioning to high school. We look forward to supporting your nominee on their road to success!
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Student First Name *
Student Last Name *
Student ID # (if known) *
What grade did the student enter in September 2021? *
Student's School Name *
Student's School Name *
Student Email Address *
Student Phone
Please describe why you feel this program will be a good fit for the student and/or why you are nominating the student for the program. *
Who completed this application? *
Did the student express interest in this program? *
Is the student aware that you submitted this nomination? *
Respondent First Name *
Respondent Last Name *
Respondent Affiliation (Examples: Teacher, School Name; Parent/Guardian; Job Title, Community Agency Name) *
Respondent Email Address *
Respondent Phone Number *
Parent/Guardian First Name
Parent/Guardian Last Name
Please provide an email address for us to contact the student's parent/guardian. If they do not have email, please provide another way to contact them (e.g., phone or mailing address).
By checking the box below, I understand someone from the Academic Mentoring Program will contact the student's parent/guardian to gauge interest and get permission for the student to participate. *
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