Education Systems Navigator Contact Form

Please fill out this form in order to contact our Education Systems Navigator. We will do our best to get back to you within 3 business days. This form is considered confidential. No information in this form will be shared with anyone outside of the Parents of Black Children team without your consent.

Email*

First Name*

Last Name*

Phone Number*

What is the best way to contact you?*

What school board is/are your child(ren) a student in?*

What is the name of your child(ren)'s school? (optional)

Main issues (check all that apply)*

Please specify issue.*

Please describe your situation/issues below in as much detail as possible to our System's Navigator.*

Have you raised concerns with your child's school/board?

Yes No

If you have already raised your concerns with your child's school/board, please describe what actions (if any) have been taken to address your concerns so far.

On a scale of 1-5 how confident do you feel in being able to navigate the education system?*

I consent to Parents of Black Children acting on my behalf as my advocate at school/school board meetings. I understand that I can withdraw this consent verbally at any time. *

I agree

I consent to the information outlined in this submission being shared with Parents of Black Children internal committees, who can provide advice and information to support me. I understand that I can withdraw this consent verbally at any time. *

I agree

I agree that by signing this form Parents of Back Children can share this information with a trusted third party (e.g. a pro bono legal team) in order to support me in navigating the system. I understand that I can withdraw this consent verbally at any time.*

I agree

I understand that Parents of Black Children will never share my personal information or identifying facts about my story in a public setting without my express consent. I understand that I can withdraw this consent verbally at any time. *

I agree

I understand that PoBC is an advocacy organization. I understand that PoBC will always prioritize my privacy and will never reveal details that will identify myself or my child. I also understand that as an advocacy organization PoBC will share non identifying aspects of my story in order to obtain systemic and transformational change for Black children and families. I give my permission for this. *

Yes No

I consent to have this information, including personally identifying information, shared with the Parents of Black Children Systems Navigator. *

I agree