BreakThru Mentor Confidentiality Agreement

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As part of my participation in the Georgia STEM Accessibility Alliance (GSAA) Virtual Mentoring Program, I, the mentor, hereby enter into this Agreement with the students participating in BreakThru and as such agree as follows:

I shall not, except as authorized by my assigned students, at any time during or after the GSAA Program disclose to any other person or entity other than the GSAA staff any proprietary, confidential, or sensitive information of or pertaining to them (collectively called "Confidential Information"), which has come into my possession, custody or knowledge during the course of the virtual mentoring and other program activities; nor shall I use any such Confidential Information for my personal use or advantage or make it available to others. I will not disclose or use, directly or indirectly, any Confidential Information, or make such Confidential
Information available to others for use in any way.

There are four conditions under which GSAA staff may breach confidentiality:

1) student poses an imminent risk of doing serious harm to self;
2) student poses an imminent risk of doing harm to others;
3) student is a victim of physical or sexual abuse;
4) mandated by a judge in a court of law.

If the student is under 18 years of age, I understand that information may be shared with parents or guardians without being considered a breach of confidentiality.

Confidential information includes: information related to a student's disability, academic performance, family information.
I understand that submission of this form constitutes a digital signature, and I hereby acknowledge that I have read this Agreement and agree to it's terms.