Authorization to Participate in Academic Support Program

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Authorization to Participate in Academic Support Program - Applications Open in January 2024

Parents, please complete the authorization, then continue to 'Request for Remote Training'

Email *

Your Name (Parent) *

Child's Birth Day *

YYYY

Giving Permission For (Student Name) *

I give my authorization for ________ to participate in the virtual academic support program sponsored by Bucknell University, Susquehanna University and Susquehanna Valley United Way. I understand that the student will be offered up to two hours per week of tutoring time, delivered over Zoom by a college student approved by the university partners, during the 2024-2025 academic school year. All tutors have their clearances and are supervised by college personnel. Tutoring sessions will be recorded for the supervision of tutors and the protection of minors. Recordings will be temporarily housed in a secure and private university media space, to be viewed by the University Supervisor only. All recordings will be deleted on or before the end of the school year.

I understand that tutoring sessions will be recorded for the supervision of tutors and the protection of minors. Recordings will be temporarily housed in a secure and private university media space, to be viewed by the University Supervisor only. All recordings will be deleted on or before the end of the school year. *

YES

Required

I understand that I may rescind this permission at any time in writing by sending a letter to the address below. *

YES

Required

By submitting a request for a tutor, you agree to the following: There are a limited number of tutors, and we cannot guarantee that a match can be made for your child. If matched, an undergraduate college student will work virtually (using Zoom or Google Meet on a computer, tablet, or phone) with your child for no more than 2 hours/week. You and the tutor will agree to a regular virtual meeting schedule. As part of the program, you will meet by Zoom with the tutor for a family meeting before beginning one-on-one sessions. At this meeting, you will be able to share your goals and provide the tutor with helpful information about your child’s needs. You will also have an opportunity to connect the tutor with your child’s teacher(s), which is an important and helpful way for your child to make progress. While the college students have been trained, they are volunteers working mostly on their own. If you have any questions, concerns, or comments about the program or your tutor, please reach out to Steph Reitmeyer at the United Way (sreitmeyer@svuw.org), who can connect you with the university program supervisor. *

YES

Required

Signature (Printed Name) *

Today Date *

YYYY

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