TutorSmart Enrollment Form 2020-2021 School Year

TutorSmart Toledo

  • Date Format: MM slash DD slash YYYY
  • A TPS and Partners in Education (PIE) partner organization (the “Partner”) who is working with a student, may request access to the student’s computerized records, including IEP data, to view personally identifiable student data. This data may also be shared with staff and volunteers working with the Partner. This would enable the Partner to identify and assign appropriate services to students. If granted access, the Partner must maintain the confidentiality of student information and not re-disclose the information to persons not identified in this consent. The Partner is only permitted to access student records to the extent necessary to perform the services agreed to by TPS and the Partner. In addition, the Partner may share information about his/her program with school district staff, in order to better serve students.

    Confidential information may only be shared to the extent that the information is relevant to the student’s educational progress, safety, or well-being. Student information may be disclosed in a grave medical emergency which necessitates facilitation of medical care.

    To the extent that it applies, the Partner also may share relevant educational data with project leadership at Partners in Education. TutorSmart works with TPS community partners, like PIE to provide technical assistance, training, and data support in order to elevate the quality of, access to, and utilization of academic after school tutoring to these identified and approved partners.

    A parent/guardian authorization is required to allow the Partner (TutorSmart) access to your child’s data. Please indicate your consent below.

    I have read the above and consent to the Toledo Public Schools to release, obtain, and exchange my child’s information with the Partner listed above.

  • Date Format: MM slash DD slash YYYY
  • By submitting this form you agree you have read this form and give your consent.

    Thank you for giving us the opportunity to work with your student this school year!! We look forward to working with them and helping them achieve their academic goals!