Parent/Guardian Permission Form

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Hello parents and guardians, please fill out this form if you are interested in your student participating in a virtual tutoring/mentoring program between Upshur County Schools and Service Scholars at West Virginia Wesleyan College.

Parent/Guardian Name: *

Parent/Guardian Email: *

Parent/Guardian Phone Number:

Name of Student: *

School: *

Student's Grade Level *

Email associated with the school provided iPad (for sending a link to the video platform where the session will take place):

How many hours a week would you like your student to meet virtually with a Wesleyan Service Scholar? *

Other:

In their profiles, the Wesleyan Service Scholars included time frames during which they are available to virtually meet with your student. Please indicate weekly day(s) and time(s) during which your student will meet with a Wesleyan Service Scholar - this should match the availability of your preferred mentor/tutor. (Ex. - Tuesdays from 10am-11am; Thursdays from 4pm-5pm) *

I understand and agree to the following terms: *

All communication with the Welseyan Service Scholar will be conducted using the above e-mail address

I give my student permission to attend weekly Zoom/Google Meet calls with a Wesleyan Service Scholar

I confirm that my student will be available at the above time(s) each week

Required

Google Meet is our preferred video-calling program. Does Google Meet work for you? *

Yes

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