2024-2025 Supervisor Recommendation for Minnesota Mentor Program (MMP): For Prospective Mentors

* Required Form *

Please complete this form to submit a recommendation for an educator, who you supervise and have shared this resource with, to participate in the 2024-2025 Minnesota Mentor Program. If you have any questions, please contact Ann Mayes at Ann.Mayes@brightworksmn.org or (612)638-1527.

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* 1. The name of the prospective mentor you are recommending for participation in the Minnesota Mentor Program:

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* 2. The low-incidence disability teaching license the prospective mentor holds:

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (B/VI)

Deaf/Hard of Hearing (B/VI)

Developmental Cognitive Disabilities (DCD)

Physical/Health Disabilities (P/HD)

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* 3. Your Name

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* 4. Your Email

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* 5. Your supervisor position/title

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* 6. School District

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* 7. Please rate the prospective mentor you are recommending in the following areas:

	Exceptional	Above Average	Average	Below Average
Committed to the concept of mentoring	Committed to the concept of mentoring Exceptional	Committed to the concept of mentoring Above Average	Committed to the concept of mentoring Average	Committed to the concept of mentoring Below Average
Friendly, approachable, and accessible	Friendly, approachable, and accessible Exceptional	Friendly, approachable, and accessible Above Average	Friendly, approachable, and accessible Average	Friendly, approachable, and accessible Below Average
Good communication skills	Good communication skills Exceptional	Good communication skills Above Average	Good communication skills Average	Good communication skills Below Average
Open-minded	Open-minded Exceptional	Open-minded Above Average	Open-minded Average	Open-minded Below Average
Reliable and dependable	Reliable and dependable Exceptional	Reliable and dependable Above Average	Reliable and dependable Average	Reliable and dependable Below Average
Committed to own professional growth and learning	Committed to own professional growth and learning Exceptional	Committed to own professional growth and learning Above Average	Committed to own professional growth and learning Average	Committed to own professional growth and learning Below Average
Gets along well with colleagues	Gets along well with colleagues Exceptional	Gets along well with colleagues Above Average	Gets along well with colleagues Average	Gets along well with colleagues Below Average

2024-2025 Supervisor Recommendation for Minnesota Mentor Program (MMP): For Prospective Mentors

* Required Form *

Question Title

* 1. The name of the prospective mentor you are recommending for participation in the Minnesota Mentor Program:

Question Title

* 2. The low-incidence disability teaching license the prospective mentor holds:

Question Title

* 3. Your Name

Question Title

* 4. Your Email

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* 5. Your supervisor position/title

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* 6. School District

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* 7. Please rate the prospective mentor you are recommending in the following areas:

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* 8. Please briefly explain why you are recommending this individual to be a mentor in the Minnesota Mentor Program.