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Hello! Our names are Jeanette Klobe and Brandie Koenig and we are working on behalf of the Perry County Community Task Force as coordinator and assistant coordinator for the CHAMPS (Communities Helping Adolescents Mature Positively & Successfully) Mentoring Program. A tremendous opportunity is available for your child to join this program. There is no cost for you, thanks to funding from various grants, and community donations. Responsible, carefully selected adults have been trained to provide support, encouragement, friendship and assistance to young people as they develop. Studies have shown that students who have mentors do better in school, are 46% less likely to begin using illegal drugs, 52% less likely to skip school, and 33% less likely to become violent. The mentor would meet with your child once a week in his/her school under supervised conditions. All adult mentors have undergone background checks. You will be encouraged to meet your child’s mentor. Your input on your child’s needs will be greatly appreciated. Please complete the enclosed checklist to help us in assisting your child. We will also ask your child’s teacher to complete the same checklist to identify the areas in which the mentor could be of most assistance to your child. To monitor the success of the mentoring project, grades, attendance, homework completions, detentions, and general attitude will be recorded. We want to do everything we can to help your child have a positive mentoring experience. If you think your child would benefit from having a mentor at school to help your child become the best he/she can be, please return the permission form on the bottom of this page in the enclosed, stamped envelope. If you have questions or need more information, please call Jeanette Klobe or Brandie Koenig at 547-1292. _____________________________________________________________________ RELEASE OF INFORMATION I give permission for a trained mentor to meet with my child. (Name of child)_______________________________________ (Birthday)___________ (School)____________________(Teacher)_________________(Grade)____ (Age)____
I also give my child’s school permission to share with the mentor and mentoring staff the teacher’s checklist and pertinent school information related to improvement in grades, attendance, behavior, attitude, and special education data. This information is needed for grant monitoring. I also give CHAMPS a release of responsibility. Parents’ Signature:______________________________________ Date ___________ Address:________________________________ Work Phone #: ___________________ Home Phone #:_____________________Best time to call:________________________ |
