Parental Permission Slip: LGBTQ+ Student Advisory Council

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Dear Parent/Guardian:

Your student has been selected to participate in Silver State Equality’s LGBTQ+ Student Advisory Council, which is tasked with addressing the needs of LGBTQ+ students’ needs in Nevada. The advisory council is made up of students and adult community leaders who provide mentorship and support the students as they navigate through their advocacy efforts. In this program, students will meet virtually via Zoom on a monthly basis for one hour. There may be times when meetings run slightly longer, when students meet as a group in-person, along with staff from Silver State Equality who oversee the program.

The adult mentors will not be assigned to one student in particular and will provide overall guidance to the group as a whole. Additionally, the adult mentors have undergone an orientation and have been screened.

We hope you will allow your student to participate in the LGBTQ+ Student Advisory Council where they will have a chance to make positive change to school climates in high school and in higher education. Completion and submission of this electronic form will serve as granting your student permission to participate for up to one year. At the end of one year, the student may be required to reapply. Please notify us should circumstances of parent/guardian permission changes.

If you have any questions, at any time, please contact Jessica Munger, council facilitator and Program Manager at 702-755-6288 or via email at jessica@silverstateequality.org.

What is your student's name? *

What school does your student attend? *

What is your name (Parent/Guardian)? *

I grant permission for my student to participate on the LGBTQ+ Student Advisory Council. *

Yes

I grant permission for my student to participate in pre and post surveys and focus groups to help us evaluate the quality of the LGBTQ+ Student Advisory Council. *

Yes

I grant permission for my student's photo to be included in future mentoring program materials. *

Yes

Parent/Guardian phone number *

Parent/Guardian email address *

I'd like to talk to staff at Silver State Equality about the LGBTQ+ Student Advisory Council before my child starts with the understanding that I can reach out to staff at anytime. *

Yes

Today's Date *

YYYY

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