Independent Learning Support
Family/Student Nomination Form

Boston Partners in Education's Independent Learning Support program matches interested 5th through 12th grade BPS students with volunteer academic mentors. Students meet virtually with mentors once a week outside of school time to improve their academic performance and receive any needed help.

Students and mentors will meet on the Google Meet video conferencing platform and all meetings will be monitored by a third party to ensure participants' safety.

If you would like to nominate your student to be matched with a mentor, please complete the following nomination form. 

Learn more about Boston Partners in Education's Independent Learning Support program.

Before submitting the nomination, please be ready to share this information:
  • Student BPS information such as email address and BPS ID number
  • The subject area your student needs support in and how you see a mentor helping them
  • Optional - The contact information for the classroom teacher of the subject your student needs support. Though it is not required, it can help us provide a quality match experience
Terms and Conditions
  1. As best I am able, I will provide a quiet space free of distraction for my student to work with a mentor.
  2. I understand that my student will need reliable internet access to participate in the program.
  3. I will communicate with the academic mentor(s) to discuss student progress and provide feedback.
  4. I will tell my student about their academic mentor and the purpose of Boston Partners in Education prior to the match starting.
  5. I will fill out a survey from Boston Partners in Education up to two times per year regarding my student’s progress.
  6. I will respond to periodic email check-ins from Boston Partners in Education staff.

School

Parent/Guardian Information







Classroom Teacher Information
Your student's classroom teacher information is not required, but can help us make the most of the match by allowing us to contact the teacher for clarification on any school work.



Participation and Data Access Permission





Page 2 of 4






Page 3 of 4

Please share what days and times your student would consistently be available to work with an academic mentor. After you select the day of the week, you'll be provided a space to input a window of time. 

Monday




Tuesday




Wednesday




Thursday




Friday




Saturday




Page 4 of 4

Student



Your student’s BPS ID number can be found on any report cards, meal cards, or other official BPS documents. If you’re unsure of the ID number, your student may already have it memorized. If you need help finding the ID number, please contact your child’s teacher or school








After you press submit, you will be required to provide an electronic signature to agree to our terms and conditions of online academic mentoring. After you sign, you will receive a verification email.

It is required for you to digitally sign and verify via email before your student is matched with an academic mentor. 

The student's parent or guardian must be the signatory on the next page. If you are completing this form on behalf of a parent/guardian, make sure their name and email are listed on the next page.

Contact Information