2024-2025 Mentor Application Minnesota Mentor Program (MMP)

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:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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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.

NW Minnesota: Regions 1 & 2 - Counties: Beltrami, Clearwater, Kittson, Lake of the Woods, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau

NE Minnesota: Region 3 - Counties: Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis

W Minnesota: Region 4 - Counties: Becker, Clay, Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, Wilkin

Central Minnesota: Regions 5 & 7 - Counties: Benton, Cass, Chisago, Crow Wing, Isanti, Kanabec, Mille Lacs, Morrison, Pine, Sherburne, Stearns, Wright

SW Minnesota: Regions 6 & 8 - Counties: Big Stone, Cottonwood, Jackson, Kandiyohi, Lac Qui Parle, Lincoln, Lyon, McLeod, Meeker, Nobles, Pipestone, Redwood, Renville, Rock, Swift, Yellow Medicine

South Central Minnesota: Region 9 - Counties: Blue Earth, Brown, Faribault, LeSueur, Martin, Nicollet, Sibley, Waseca, Watonman

SE Minnesota: Region 10 - Counties: Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, Winona

Twin Cities Metro: Region 11 - Counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington

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

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (B/VI)

Developmental and Cognitive Disabilities (DCD)

Deaf/Hard of Hearing (D/HH)

Physical/Health Disabilities (P/HD)

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

Yes (Please specify which school year/s.)

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

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (B/VI)

Deaf/Hard of Hearing (D/HH)

Developmental and Cognitive Disabilities (DCD)

Physical/Health Disabilities (P/HD)

Other - please list

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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.)

College/University Teacher Preparation Program - Professor or Adjunct Professor

University-Level Supervisor

Cooperating Teacher for Pre-Service (Student Teacher)

Not applicable

Other (please describe)

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

Yes

(Note: if you have been retired more than 5 years, please explain how you've stayed current in the field.)

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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.

I am an itinerant teacher and provide services in the following settings:

Setting I - Students receive special education services outside the regular education classroom for less than 21 percent of the day.

Setting II - Students receive special education services outside the regular education classroom, typically a resource room, for 21 percent to 60 percent of the school day.

Setting III - Students are outside of the regular education classroom for more than 60 percent of the day.

Setting IV - Students receive special education services at separate school facilities for more than 50 percent of the school day.

I am comfortable guiding new special education teachers in reflection to help facilitate their professional growth.

I am willing to devote time and energy for mentoring and complete electronic forms to share how I use my time.

I am not an administrator.

I have strong interpersonal skills, am a good listener and am able to establish a respectful, confidential mentoring relationship.

I set high expectations for myself and others.

I am skilled in using data to improve instruction in my field.

I feel confident in my ability to write IEP/IFSP goals and evaluations using best practices in my field and can communicate them confidentially with others by keeping data privacy.

I can locate and share resources to support instruction and lesson planning ideas for others.

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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. If you are matched as a mentor, which platform are you comfortable using?

Google Form (I have access to a Google account.)

Fillable PDF

Either one

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* 28. 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.

Yes

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* 29. 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.)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

2024-2025 Mentor Application Minnesota Mentor Program (MMP)

Mentor Application

Question Title

* 1. Name (First and Last)

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* 2. School Email

Question Title

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

Question Title

* 4. Phone/Text Number

Question Title

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

Question Title

* 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.

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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 21

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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. If you are matched as a mentor, which platform are you comfortable using?

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* 29. 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.)

* 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.)

* 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.

* 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.

* 29. 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.)