Nominate: Independent Learning Support

Boston Partners in Education's Independent Learning Support program matches interested 3rd 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. Please direct any questions to Claire Hammer via email at [email protected] or call 617.451.6145.

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

Please note: this form is for parents/guardians of BPS students, or students who are over 18 years old. Teachers or other school staff can nominate students for an in-school academic mentor through our other programs linked here. I am a....

Terms and Conditions

As best I am able, I will provide a quiet space free of distraction for my student to work with a mentor.
I understand that my student will need reliable internet access to participate in the program.
I will communicate with the academic mentor(s) to discuss student progress and provide feedback.
I will tell my student about their academic mentor and the purpose of Boston Partners in Education prior to the match starting.
I will fill out a survey from Boston Partners in Education up to two times per year regarding my student’s progress.
I will respond to periodic email check-ins from Boston Partners in Education staff.

Do you agree?

Yes, I have read these terms and conditions, and I agree to them.

Parent/Guardian Information

Salutation

First Name

Last Name

Email

Phone

Best Contact Time

Best Contact Method

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.

First Name

Last Name

Email

School

Select the school your student attends

Participation and Data Access Permission

I give permission for my student to work with a Boston Partners in Education Academic Mentor in a monitored online setting.

Yes

I give permission for a copy of my student’s BPS ID number; term course grades in core academic

subjects including History, English, Math, and Science; term average daily attendance;

responses to Student Climate Survey items: Perceptions of School and Enthusiasm for Learning;

and promotion information to be given to Boston Partners in Education by the Boston Public Schools. I understand that this data will be kept confidential and will be deleted after one year.

I give permission for Boston Partners in Education or its representatives to use the following perpetually in Boston Partners in Education's newsletters, website, Big Cheese Reads Gala and other

special events, official social media sites (including but not limited to Facebook, YouTube, LinkedIn and

Twitter), recruitment material or in the media without compensation:

Boston Partners in Education may use my student’s first name (but not last name), student’s spoken words,

student’s quotes, student’s photo, video of my student, and student’s likeness.

I hereby release my student’s school and Boston Public Schools from any claims arising out of my student’s

comments or participation in these works. Use of these will aid us in promoting the work Boston

Partners in Education does in support of Boston Public Schools students, including recruitment

of volunteers and cultivating new and current donors.

Are you or someone in your household able to monitor the interactions between your student and their volunteer academic mentor? For more information about monitoring, click here.

Emergency Contact - Must Be Over 18

First and Last Name

Relation to you

Email

Phone

Best Contact Method

School

Select the school you attend

Classroom Teacher Information

Your teacher's 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.

First Name

Last Name

Email

Participation and Data Access Permission

I give permission for Boston Partners in Education Academic Mentor to match me with an academic mentor in an online setting.

Yes

I give permission for a copy of my BPS ID number; term course grades in core academic

subjects including History, English, Math, and Science; term average daily attendance;

responses to Student Climate Survey items: Perceptions of School and Enthusiasm for Learning;

and promotion information to be given to Boston Partners in Education by the Boston Public Schools. I understand that this data will be kept confidential and will be deleted after one year.

I give permission for Boston Partners in Education or its representatives to use the following perpetually in Boston Partners in Education's newsletters, website, Big Cheese Reads Gala and other

special events, official social media sites (including but not limited to Facebook, YouTube, LinkedIn and

Twitter), recruitment material or in the media without compensation:

Boston Partners in Education may use my first name (but not last name), my spoken words,

my quotes, my photo, video of me, and my likeness.

I hereby release my school and Boston Public Schools from any claims arising out of my

comments or participation in these works. Use of these will aid us in promoting the work Boston

Partners in Education does in support of Boston Public Schools students, including recruitment

of volunteers and cultivating new and current donors.

Needs extra help in subject	Needs extra attention
Speaks English as a second language	Lacks overall confidence
Lacks confidence in subject	Not motivated about subject
Lacks study skills	Advanced in subject & needs challenge
Social-emotional connection	Needs help following through to complete work

Need extra help in subject	Need extra attention
Speak English as a second language	Lacks overall confidence
Lack confidence in subject	Not motivated about subject
Lack study skills	Advanced in subject & needs challenge
Social-emotional connection	Need help following through to complete work

Independent Learning SupportFamily/Student Nomination Form

Participation and Data Access Permission

Participation and Data Access Permission

Independent Learning Support
Family/Student Nomination Form