Exit 1181 MDCPS Mentor Teacher Interest Survey Question Title * 1. Greeting/Salutation Ms. Mrs. Mr. Dr. Question Title * 2. Last Name Question Title * 3. First Name Question Title * 4. Email Question Title * 5. Phone Question Title * 6. Employee Number Question Title * 7. Work Location Number Question Title * 8. School Name Question Title * 9. School Address Question Title * 10. Principal Salutation Ms. Mrs. Mr. Dr. Question Title * 11. Principal First Name Question Title * 12. Principal Last Name Question Title * 13. Principal's Email Question Title * 14. What grade level will you teach? Elementary (3-5grade only) Middle School (6-8grade) High School (9-12grade) Question Title * 15. Middle School Teachers ONLY: Would you like to host students from the combined course? (these students will visit 7 times - 2 times to observe and 5 times to teach). You will be provided an increased stipend. Yes No Question Title * 16. How many PAIRS of students are you interested in mentoring? 1 pair (ie 2 students) 2 pairs (ie 4 students) Question Title * 17. In what subjects would you like to mentor students? Math Science (must be a minimum of 45mins) Both High School Teachers: Please indicate your exact subject(s) below. Question Title * 18. Have you served as a Mentor Teacher for FIUteach? Yes No Question Title * 19. Do you have clinical education certificate? Yes No, but I am willing to enroll in the course while simultaneously hosting students. Done