Student & Parent Consent · Middle School

Project THRIVE

THRIVE
JD Health & Wellness in partnership with
Salem-Keizer Public Schools

Your school is offering Project THRIVE — a weekly mentoring program where you meet with a trusted adult to check in on how school and life are going. Fill this out with your parent and sign below to join.

What THRIVE is
A weekly check-in — just for you.
  • A trained Community Health Worker meets with you every week
  • 10–15 min as a group, plus a short 1-on-1
  • Talk about school, friends, stress — whatever's on your mind
  • Free, during the school day, no extra homework
What THRIVE is not
Not therapy. Not trouble.
  • Not therapy or clinical treatment
  • Not discipline — you're not in trouble
  • Not graded, not on your report card or school record
  • Not a replacement for teachers, counselors, or your parents

Things to know before you sign.

Who will I meet with?
A trained Community Health Worker from JD Health & Wellness. Background-checked, trained to work with middle schoolers, and works closely with your school counselor.
Will my parents hear about everything?
Your parents will be told the big-picture stuff — how you're doing, if anything comes up they should know about. Day-to-day conversations stay between you and your CHW. Safety concerns are always shared with your parents and school staff right away.
Is my information private?
Yes. Notes are protected under FERPA and only shared with your CHW, school counselor, and the THRIVE team. Not shared outside the school without your parent's permission.
What if I need more than a check-in?
Your CHW helps connect you and your family to the right support — a school counselor, tutor, community resource, or clinical care if needed.
Can I stop if it's not working?
Yes. Participation is voluntary. You or your parent can stop anytime by telling the school counselor or the THRIVE team.
Is there a cost?
No. There is no out-of-pocket cost for THRIVE — it is provided through the partnership between JD Health & Wellness, Salem-Keizer Public Schools, State Grants and your insurance provider.
✓

Consent received.

Thanks for signing up for Project THRIVE. The THRIVE team and your school counselor have been notified, and someone will be in touch within a few school days to confirm next steps.

A confirmation copy has been emailed to the address you provided. If you don't see it within an hour, check your spam folder.

Project THRIVE  ·  Student & Parent Consent (MS)
Questions? Contact your school counselor or the THRIVE team.