MMP 2021-2022 Protege Application

Minnesota Mentor Program (MMP) 2021-2022 Protégé Application

Please complete this survey in order to apply as a protégé for the 2021-2022 MMP. If you have any questions, please contact Ann Mayes at Ann.Mayes@metroecsu.org or (612) 638-1527.

If you would like to apply as an MMP mentor, please utilize the MMP Mentor Application.

***Please share the following link with your supervisor so they can submit an MMP Recommendation on your behalf: Required: MMP Supervisor Recommendation ***

Question Title

* 1. Name (First and Last)

Question Title

* 2. Position / Title for Fall 2021

Question Title

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

NW Minnesota: Regions 1 & 2 - Counties: Beltrami, Clearwater, Hubbard, 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)

Question Title

* 4. District

Question Title

* 5. Please check the categorical area for which you are applying to be a protégé:

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (BVI)

Developmental and Cognitive Disabilities (DCD)

Deaf/Hard of Hearing (DHH)

Physical/Health Disabilities (PHD)

Question Title

* 6. Have you participated as an MMP protégé in past years?

Yes (Please specify which year/years)

Question Title

* 7. Email

Question Title

* 8. Phone/text number

Question Title

* 9. Mailing address for MMP-related materials or communications

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 10. Please indicate which Minnesota teaching license(s) you currently hold

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)

Other - please describe

Question Title

* 11. Indicate your license tier.

Tier 1

Tier 2

Tier 3

Tier 4

Question Title

* 12. Minnesota license file folder number

(If you don't know your file folder number, you can find it at MN License Lookup

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.

Question Title

* 13. Birth-3 years

Question Title

* 14. 3-5 years

Question Title

* 15. Elementary school students

Question Title

* 16. Middle school students

Question Title

* 17. High school students

Question Title

* 18. Post-secondary

Question Title

* 19. Please describe why you are requesting support from a mentor and what you hope to gain from the MMP.

(Note: If you have participated as an MMP protégé in past years and your answer to this question has not changed, please feel free to indicate 'See previous MMP Protégé Application' for this question.)

Question Title

* 20. What challenges do you believe you will face as a protégé?

(Note: If you have participated as an MMP protégé in past years and your answer to this question has not changed, please feel free to indicate 'See previous MMP Protégé Application' for this question.)

Question Title

* 21. Please upload a copy of your current resume.

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

MMP 2021-2022 Protege Application

Minnesota Mentor Program (MMP) 2021-2022 Protégé Application

Question Title

* 1. Name (First and Last)

Question Title

* 2. Position / Title for Fall 2021

Question Title

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

Question Title

* 4. District

Question Title

* 5. Please check the categorical area for which you are applying to be a protégé:

Question Title

* 6. Have you participated as an MMP protégé in past years?

Question Title

* 7. Email

Question Title

* 8. Phone/text number

Question Title

* 9. Mailing address for MMP-related materials or communications

Question Title

* 10. Please indicate which Minnesota teaching license(s) you currently hold

Question Title

* 11. Indicate your license tier.

Question Title

* 12. Minnesota license file folder number(If you don't know your file folder number, you can find it at MN License Lookup

Question Title

* 13. Birth-3 years

Question Title

* 14. 3-5 years

Question Title

* 15. Elementary school students

Question Title

* 16. Middle school students

Question Title

* 17. High school students

Question Title

* 18. Post-secondary

Question Title

Question Title

* 20. What challenges do you believe you will face as a protégé?(Note: If you have participated as an MMP protégé in past years and your answer to this question has not changed, please feel free to indicate 'See previous MMP Protégé Application' for this question.)

Question Title

* 21. Please upload a copy of your current resume. (Note: If you have participated as an MMP protege in past years and your resume has not changed, you do not need to upload a file.)

* 12. Minnesota license file folder number

(If you don't know your file folder number, you can find it at MN License Lookup

* 20. What challenges do you believe you will face as a protégé?

(Note: If you have participated as an MMP protégé in past years and your answer to this question has not changed, please feel free to indicate 'See previous MMP Protégé Application' for this question.)

* 21. Please upload a copy of your current resume.

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