RHS MENTORING PROGRAM

PARENT/GUARDIAN PERMISSION FORM

Date: Sunday, January 25, 2015
Dear Parent/Guardian:
Your child has been selected to participate in a program, Rosemount High School Faculty Student Mentor
Program, created by Rosemount High School Administration. In this program, students will be paired with a
designated faculty member to provide academic advising and school transition assistance. A mentor is a caring
adult volunteer who is willing to spend time helping a young person succeed.
The mentors have been carefully screened and trained. Young people and mentors are asked to meet face-toface, during school hours. Any meeting must take place in our building unless a parent provides written
permission.
In addition, your child will be asked to complete two questionnairesone before he or she is matched with a
mentor and the second near the end of the programto help us measure and evaluate the benefits and
effectiveness of the RHS Faculty Student Mentor Program. Your child may also be asked to participate in a
focus group together with the project evaluators and other youth in the program. In both surveys and focus
groups, your child may be asked to tell us about his or her opinions and experiences with the mentor. Your
childs questionnaire information will be kept confidential and seen only by school staff. We believe
summarizing the broader findings will help us strengthen RHS Faculty- Student Mentor Program.
We will assume that you approve of your childs participation unless you contact me by phone at (651) 4237501 or check the box below and return this form that declines your childs involvement with the program. We
hope that you will approve of having your child participate in this exciting program.
If you have any questions, please call me.
Sincerely,
_______________________________________
(Principal John Wollersheim)
1) ____ (Initials of parent/guardian) I do not grant permission for my child, (______________), to participate in
RHS Mentor Program and be matched with a mentor.
_____________________
Parent/Guardian Signature

_______________
Date

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RHS Faculty-Student Mentor Program, 2014