2026-2027 Mentor Application Minnesota Mentor Program (MMP) Survey

Mentor Application

Please complete this survey in order to apply as a mentor for the 2026-2027 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: 2026-2027 Supervisor Recommendation for MMP: For Prospective Mentors * The link is also located on the Minnesota Mentor Program webpage.

Please note that mentors will not be matched with a protege until the 2026-2027 Supervisor Recommendation has been received.

1.Name (First and Last)(Required.)

2.School Year Email(Required.)

3.Summer Email - needed for MMP updates, announcements, pairings in June, July and August(Required.)

4.Phone/Text Number(Required.)

5.Your home (not school) mailing address for Minnesota Mentor Program-related materials to be sent to:(Required.)

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

6.School District (where you are employed)(Required.)

7.Low-Incidence Disability Teaching Position for 2026-2027(Required.)

8.Indicate which region of the state that you teach in.(Required.)

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

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

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)

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

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

11.Minnesota File Folder Number: Minnesota Educator License Lookup
(Required.)

12.How many years of teaching experience have you, or will have, completed as of June 2026?

(A minimum of 5 years experience in the specific low-incidence disability field is required to be a mentor.)(Required.)

13.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.)(Required.)

College/University Teacher Preparation Program - Professor or Adjunct Professor

University-Level Supervisor

Cooperating Teacher for Pre-Service (Student Teacher)

Not applicable

Other (please describe)

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

Yes

(Note: if you are retired, please explain how you are staying current in the field.)

15.In what positions have you taught students with low-incidence disabilities?

Select as many that apply to your teaching experience.

This information will help match you with a protégé who needs a mentor with similar experiences.(Required.)

I am, or have been, an itinerant teacher and provide services to students with low-incidence disabilities in multiple settings below (Please check which settings you've provided itinerant services in).

I am, or have been, a resource teacher and have taught students with low-incidence disabilities in setting II.

I am, or have been, a classroom teacher and have taught students with low-incidence disabilities in settings III, IV, V, VI, VII, and/or VIII).

16.Select as many settings that apply specifically to your teaching experience with students with low-incidence disabilities.

This information will help match you with a protégé who needs a mentor with similar experiences.(Required.)

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.

Setting V - Students receive special education services at a private, separate day school for more than 50 percent of the school day.

Setting VI - Students receive special education services at a public residential facility for more than 50 percent of the school day (e.g., MN State Academies).

Setting VII - Students receive special education services at a private residential facility for more than 50 percent of the school day.

Setting VIII - Special education services are delivered in a homebound or hospital or home-based setting.

For each category of students listed below, rate your level of experience in the low-incidence disability field that you are applying to be a mentor, using a scale of 0 to 4, with 0 indicating no experience and 4 indicating the most experience.

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

19.Kindergarten - Grade 5 (Elementary School)(Required.)

22.Post-school/Transition Programs - Up to Age 22(Required.)

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

I am not an administrator.

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

I am willing to devote time and energy for mentoring and complete the MMP electronic forms that share how I support and provide resources to my protege.

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 low-incidence disability 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.

24.Explain why you want to be a mentor. Include what you think you can contribute to the mentoring experience, as well as what you will gain professionally by being a mentor in the field.(Required.)

25.What challenges do you feel you might face as a mentor?(Required.)

26.If you were an MMP mentor last year, do you want to be matched with the same protégé?

Note: If you already had the same protégé for the last two years, the MMP will match you with a different protégé, so protégés can learn different aspects of the field, strategies, and to expand their networks.

Yes

Add additional information that would be helpful in making matches.

27.If you know a teacher in your region who will apply to be an MMP protégé, and the two of you would like to be matched together, please write their name below.

Note: If you and the protege are teaching in the same low-incidence disability field and are in the same school building or district, we recommend that you work through your school / district to provide support as a mentor to that protégé.

28.MMP mentors are expected to attend the virtual MMP Kick-Off in the morning of August 6, 2026, and meet briefly with their protégés, and receive a stipend. If they are unable to attend, then they are expected to watch the recording and meet their protégé before the school year begins to establish a connection.

Mentors are also strongly encouraged to attend the mid-year virtual mentor-only workshop (typically in mid-January).

Will you attend the MMP Kick-Off in August? But if unable, will you communicate your plan to MMP to watch the recording as well as connecting with your protégé before the school year begins?(Required.)

Yes

These are my questions:

29.Have you sent the 2026-2027 Required 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. The supervisor recommendation required for mentors before being accepted and matched with a protégé.(Required.)

Yes

30.Have you participated as an MMP mentor in the past five years?(Required.)

Yes (Please specify the most recent school year you were an MMP mentor.)

31.Please upload a copy of your current resume.

** This is required only for new mentors. **

(Note: If you have participated as an MMP mentor within the past five years, and your resume has not changed, you do not need to upload it again.)

No file chosen

Send me a copy of my responses via email