MTC Mentoring Program Permission Form

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Your student has an opportunity to participate in the Mentor Tutor Connection (MTC) Mentoring Program. This program is designed to partner a student with an adult mentor. The mentors are adults from our local community who represent many different careers. The mentor will spend quality time with your student at least twice a month. The mentor covers any expenses during that time.

The mentors have volunteered through MTC, a community-based organization whose goal is to recruit, inform, and encourage volunteers to help meet the educational and social needs of youth in the Mountain View, Los Altos, and Los Altos Hills area. All mentors are fingerprinted, trained, and cleared by the FBI, Department of Justice, and DMV before they meet with the students. As soon as your student is matched with a mentor, we will let you know!

Please read and digitally sign this Permission Form. If you have any questions about the mentoring program, please feel free to call or e-mail me.

Jennifer Springer, Mentor Program Manager, Mountain View High School
‭(650) 520-7776 ‬jennifer@mentortutorconnection.org‬

Email *

Student's Full Name *

Student's Phone Number *

I hereby certify that I am the parent or legal guardian of the aforementioned student and I give my permission for my student to participate in the Mentor Tutor Connection Mentoring Program. I also grant permission for my child to ride in a car driven by their mentor, another mentor, or a Mentor Tutor Connection staff member. I understand that some activities may take place outside of Santa Clara County. Please record your name below which will serve as your signature. *

Parent or Guardian’s Legal Name *

Today's Date *

YYYY

I give permission for photos of my student to be used, if selected, for a brochure, Facebook page, presentation, or other publicity about the Mentor Program. *

YES

A copy of your responses will be emailed to the address you provided.

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