Dream Bigger Mentoring Program Enrollment Form (2022-23)
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 for the 2022-2023 school year.

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 have a capacity of 15 students per school:

Astor Elementary School: 7 openings
Faubion School: Waitlist Available (5)
Harriet Tubman Middle School: Waitlist Available (3)
Ockley Green Middle School: 3 openings

Sign in to Google to save your progress. Learn more
Clear form
Never submit passwords through Google Forms.
This form was created inside of Coalition of Black Men. Report Abuse