ANY One-To-One Mentoring Program

Des Moines Public Schools’ AmeriCorps Program Big Brothers Big Sisters Middle School Mentoring Parent/Guardian Information Letter

Dear 6th Grade Parent/Guardian, Your child has been recommended to participate in a new, exciting mentoring program called Pathways to Success. This program is a joint effort between DMPS and Big Brothers Big Sisters of Central Iowa (BBBS). Pathways to Success will use one-to-one and small group mentoring relationships to introduce students to career and educational opportunities. Mentors will meet their students regularly at their middle school. Throughout the school year, students will visit their mentor’s company (up to 3 visits) to expose them to career opportunities within a real working environment. The Pathways to Success program takes place every Wednesday of each month after school from 1:00-2:00 pm. Transportation is provided to and from field trips to their mentor’s business, but transportation is NOT provided at 2:00 pm when the program is over. Transportation will need to be arranged for your child.

In addition to having a career focus, during each meeting your child will listen to short presentations provided by Employee Family Resources (EFR) on subjects such as time management, goal setting, self-image, peer pressure, bullying, substance abuse prevention, etc. Your child and his/her mentor will develop a friendship and bond by spending time together on a consistent basis which, in turn, will help your child improve their self esteem and skill levels that will hopefully improve their performance both at school and at home. Volunteer mentors are interviewed and assessed for approval by Big Brothers Big Sisters of Central Iowa. BBBS runs background checks and requires references from all potential volunteers. You are invited and encouraged to meet the mentor matched with your child and you are welcome to contact us at any time concerning the match. General information regarding your child’s school performance and behavior will be collected from school personnel. A BBBS Mentoring Coordinator will conduct a short 15 min. interview with your child at their school to determine his/her personal interests for match compatibility and their desire to participate in the program. All information collected regarding your child will be held in confidence.

Please complete and return the permission slip and parent/guardian questionnaire as soon as possible to allow your child to participate in this program. If you have any questions, please contact either of the names below.

Thank you for your cooperation and desire for a school-based mentor for your child. We’re looking forward to working with you and providing this additional support for your child! Sincerely,

Angela Beaman Alyson Goetzl [email protected] [email protected] (515) 288-9025 ext. 239 (515) 288-9025 ext. 234 School-Based Middle School Coordinator, DMPS Liaison School-Based Mentoring Coordinator

Big Brothers Big Sisters of Central Iowa champions mentoring – Connecting our youth with role models for proven positive results.

Parent Authorization Big Brothers Big Sisters of Central Iowa will keep any and all information and documents provided to staff members of any individual that participates in any Agency programs strictly confidential as permitted by the law of the State of Iowa. In order to be in compliance with Agency reporting guidelines and/or grant requirements, Big Brothers Big Sisters of Central Iowa requests all of the following questions be answered. Big Brothers Big Sisters of Central Iowa has a confidentiality policy that guides our ongoing business.

My signature acknowledges and agrees that; 1. I grant permission for my daughter/son to participate in the BBBS Pathways to Success Mentoring program at my child’s school and continue, if they choose to, to participate in BBBS Mentoring program following 6th grade. 2. I authorize the school and BBBSCI to share information regarding my child’s school performance and behavior throughout the match. 3. I understand there is to be no in-person contact between my child and the mentor outside of the school setting except for planned group activities provided by Agency and/or the school or until we have enrolled in the School Based Plus program. Match parties may have contact by telephone or mail. 4. I commit I will not allow my child to be transported at any time by the mentor. I authorize agency or school staff to provide transportation in emergency situations. I commit I will pick my child up or I will make arrangements for my child to be picked up after the Pathways to Success program. 5. I authorize Big Brothers Big Sisters of Central Iowa, Des Moines Public Schools and Mentor Business Partners to use my child’s name, general information and picture/video taking for marketing purposes. 6. I authorize my child to participate in Pathways to Success sponsored field trips. These trips will occur 3 times (all Wednesdays after school) throughout the school year. 7. Yes No I am interested in enrolling my child in the School Based Plus Program. I understand I will be notified by my child’s case manager before the program begins with my child.

______Signature of parent/guardian Date

______Child’s Name (Please print) Birthdate (month/day/year) Child’s school Grade Race: White African American Native American Hispanic African American/White Native American/White Asian African American/Native American Native American/Asian Asian/White African American/Asian Other ______Gender: Female Male

______Parent/Guardian name (please print) Address Apt City Zip Code

______Second Parent’s name (if child is living in a two parent household or joint custody, etc)

______Home phone Work phone Cell phone Email address

Parent/guardian’s employer(s): ______

Parent/guardian Living Situation Household income Does your child qualify for free or One parent (female) Less than $25,000 reduced lunches at school?

One parent (male) $25,000 - $49,999 Yes No Two parents $50,000 - $74,999 Other Relative(s) $75,000 - $99,999 Joint Custody Over $100,000 Foster home Other ______Please complete the following questions to help us get to know your child better.

What are your expectations and hopes for your child’s match?

Do you have any preferences (age, race, ethnicity, family background, etc.) as to the type of mentor your child is matched with?

We make every attempt to match Little Brothers with Big Brothers, but if a Big Brother is not available, are you open to your son having a Big Sister?

Describe your child’s personality and behavior. □ Respectful □ Frustrated □ Confident □ Unappreciative □ Quiet □ Happy □ Discouraged □ Aggressive □ Outgoing □ Hard Worker □ Impatient □ Energetic □ Cooperative □ Motivated □ Uncaring □ Loud

What are your child’s talents and interests? □ Arts/Crafts □ Animals □ Reading □ Video Games □ Sports □ Board Games □ Movies □ Outdoor Activities □ Music □ Computers □ Cooking/Baking □ Indoor Activities

Describe any concerns you may have about your child. □ Decision Making □ Drug/Alcohol Issues □ Medical Concern □ Outgoing □ Bullying/Getting Bullied □ Mental Abuse □ Belligerence (acting out) □ Friendship Skills □ Physical Abuse □ Hyperactive □ Profanity □ Sexual Abuse □ Loner □ Sibling/Peer Jealousy □ Academics □ Hygiene issues □ Stealing □ Gang Issues □ Other

Describe any major life changes your family may have over the next year or have had in the past year (moving, transferring schools, divorce/separation, etc.).

Has your child received any professional counselor or seen a therapist in the last year? If yes please list name and address

What have your child’s teachers told you about your child’s academic progress? Are you satisfied with how your child is doing academically?

What does your child tell you about school?