Partners Program Application

For Lower and Middle School Students

If you identify your lower or middle school student from a historically marginalized group, underrepresented population, or a student of color (see the definition we use below), please complete this application form by September 17, giving as much information as possible about your child.

If you have any questions about the program feel free to contact Akira Townes, Director of DEI or Kyle Tribble, DEI Fellow.

Person/People of Color — NAIS (National Association of Independent Schools) considers ‘People of Color’ as individuals who are permanent residents or U.S. citizens and belong to one of the following racial/ethnic groups:  African American, Latino/Hispanic American, Asian American/South Asian, Native American, Middle Eastern American, Multiracial American, and Pacific Islander.

2022 - 23 Partners Program

Participated in the Partners’ Program Last Year?

I would like to keep my pairing from last year

Just fill out the top part of this form if you want to keep your pairing from last year.

Parent/Guardian Name(Required)

First Last

Student Name(Required)

First Last

Our family will attend the Partners’ Kickoff Event on September 10(Required)

Yes

Number of Adults Attending September 10(Required)

Number of Children Attending September 10(Required)

Parent/Guardian Information

Parent/Guardian Name(Required)

First Last

Parent/Guardian Email Address(Required)

Primary Phone Number(Required)

Secondary Phone Number

I prefer to receive information by(Required)

US Mail

Phone

Student Information

Student Name(Required)

First Last

Student Grade Level(Required)

Please enter a number less than or equal to 12.

My child is identified racially as... (see NAIS definition above)(Required)

Partner Preferences (select one)(Required)

Comments

Please list five words that best describe your child.(Required)

Child’s interests(Required)

Activities your child is involved in both in and out of school

My child would respond best to a student who is...(Required)

Health concerns

Any other concerns

For Parents

Are there issues of diversity that you would like The Partners Program to address with Lower, Middle, or Upper School students? If so, please describe.

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