Appendix A

Please sign and return the following page to your child's Senior English Academic Partner.

Parent/Guardian/Student Permission and Liability Form

I have read the Letter to Students and Families relating to the Pride Project and understand that the satisfactory
completion of the research paper, 10 project hours, product, and presentation are required to graduate and
receive a diploma from Pine Lake Preparatory. I also understand that the student and his / her parents are
responsible for any damage or injury to the student or others during the students self-selected Pride Project
hours.

Parent/Guardian Name(s) (please print) Renae and Bill Shehane

Parent/Guardian Home Phone(s): N/A
Work Phone(s): (704) 516-0080 (Mother) (704) 907-5076 (Father)
Parent/Guardian Email(s): rhshehane@bellsouth.net
bshehane@seamancorp.net

Parent/Guardian Signature ___________________________________________ Date ____________

(2ND Signature Optional)

___________________________________________ Date ____________

Student Signature

___________________________________________ Date ____________

Appendix C

Mentor Consent Form

The role of the Mentor is to serve as an expert in the field chosen by the student. By signing this form, the
mentor agrees to: allocate time (a minimum of ten hours) to work with the student; provide insight into the
training, expectations, and demands of the field; ensure that the student is actively involved during shadowing
and not simply observing. If desired, the mentor may provide suggestions, advice, and support regarding the
development of a tangible product that connects to the real-world requirements of the career.
Student Name William Shehane
Project Topic Architecture

Mentor Name Rob Heffner

Place of Employment _____________________________________________________________
Work Address ____________________________________________________________________
Preferred Email __________________________________________________________________
Preferred Phone _________________________
Occupation / Title / Expertise Related to Topic ___________________________________________
________________________________________________________________________________
Years of experience in topic area ____________________

For the protection of myself and the student, I agree that we will not meet alone. I agree to uphold the
roles/duties of the project mentor to the best of my ability. I also confirm that I am not related to the student.
Mentor Signature ________________________________________________ Date ______________
Parent Signature _________________________________________________ Date ______________
Student Signature ________________________________________________ Date ______________