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I have read the Letter to Students and Families relating to the Pdde Prcject and uodemtand that the satisfactory
completion of the research paper, 10 project hours, pioduct, and presentatio[ are required to graduate and
receive a diploma from Pine Lake Preparatory. I also understand that the student and his / her parcnts arc
responsible for any damage or iqiwy to the studeot or others during the student's self-selected Pdde Project
hours.

ParenVGuardian Name(s) (please print)

ParenVGuardian Home Phone(s):

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Work Phone(s):

Parent/Guardian Email(s)

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(Father)

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Parent/Guardion Signature
(2m Signature Optional)

Date

Student Signature

Date

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Mcntor Conseut Fonn

lhc role oIlho \'lelllor is lo serve as au expert iD the iield cboscn b)'the slLtderi. lly sig ing this fo1m, the
nle[tor agrecs lo: allocate lilnc (a mi imum of tcn i]ours) 10 work with l-he student; plovicle insighl into the
Lrxiolng, expcctllions. and dcmands ol the ficldl ensure thill the stLrdell is aclively involvecl duing shadouing
and not simply observi[g. 11'clcsircd, the nlenlol may provide sLrggestious, advice, and suppoI1 regerdjng thc
dcvciopmcrt of a laDgible producl lhat conDccLs lo the 1eal-world rcquilemquts oflhc calccl'

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Mentor Namc

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Jrrcltred Email
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Occupari,n

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ll1c protcctioD of my''self antl lhe stl(lerll, I a-eree that wc rvill uol mccl alonc. I rgrcc lo rLphold
rolcsl.luties ollhc proiect lncntur b thc bcst ol m),abilit). I also conlirm thrl I anl not rclaLc(l io ihc sludcnl.

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Mcntor Signature

Date

PArcnt Signature

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Student Signatur

Date

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