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Mentor Application

Please complete this survey in order to apply as a mentor for the 2024-2025 Minnesota Mentor Program. If you have any questions, please contact Ann Mayes at Ann.Mayes@brightworksmn.org or (612)638-1527.

***Please share the following link with your supervisor so they can submit the Required Supervisor Recommendation on your behalf: Required: 2024-2025 Supervisor Recommendation for MMP: For Prospective Mentors *** The link is also located on the MMP webpage.

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* 1. Name (First and Last)

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* 2. School Email

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* 3. Summer Email (might be personal - needed for MMP updates, announcements, pairings in June, July and August)

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* 4. Phone/Text Number

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* 5. Your mailing address for Minnesota Mentor Program-related materials to be sent to:

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* 6. Current position/title (indicate which low-incidence disability area, especially if you have more than one licensure)

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* 7. School District

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* 8. Indicate which region of the state that you teach in.

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* 9. Indicate the categorical area of low-incidence disability license for which you are applying to be a mentor:

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* 10. Have you participated as an MMP mentor in past years?

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* 11. Indicate which Minnesota teaching license(s) you currently hold (select all that apply)

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* 12. Minnesota File Folder Number: Minnesota Educator License Lookup

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* 13. How many years of teaching experience have you completed as of June 2024?

(A minimum of 5 years experience is required to be a mentor in MMP.)

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* 14. In addition to your teaching experience, in what other capacities in the field of special education have you also worked? (Check all those that apply.)

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* 15. Are you retired from the field of licensure in which you wish to mentor?

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* 16. In what placement setting(s) have you served?

Select as many that apply to your teaching experience.

This information will help match you with a protégé who might have similar experiences.

For each category of students listed below, rate your level of expertise using a scale of 0 to 4, with 0 indicating no experience and 4 indicating the most experience.

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* 17. Birth-2 years (Part C - Early Childhood)

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* 18. Ages 3-5 years (Preschool)

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* 19. Kindergarten - Grade 5 (Elementary School)

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* 20. Grades 6 - 8 (Middle School)

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* 21. Grades 9 - 12 (High School)

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* 22. Post-school/Transition Programs - Up to Age 22

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* 23. Self-Reflection as a Mentor:  Consider these statements as they apply to you as a mentor.

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* 24. Describe why you want to be a mentor. Include what you think you can contribute to the mentoring experience as well as what you think you will gain.

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* 25. What challenges do you feel you might face as a mentor?

If you have participated as an MMP mentor in the previous year or years past, describe some common challenges you experienced or protégés seem to experience.

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* 26. If you know a teacher in your district or region who will apply to be an MMP protégé, and you two would like to be matched together, please write his/her name below.  Note: This applies only if you are not already currently matched  with the same protégé in your district.

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* 27. Have you sent the Supervisor Recommendation link to your supervisor, special education director, or special education coordinator to complete on your behalf? If not yet, please send it to complete your application, as the supervisor recommendation required for mentors before matching with a protégé.

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* 28. Please upload a copy of your current resume if you are new to the MMP. 
An uploaded resume is required for completion of your application.


(Note: If you have participated as an MMP mentor in past years and your resume has not changed, you do not need to upload a file.)

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