2022-2023 Mentor Application for Minnesota Mentor Program (MMP)

Mentor Application

Please complete this survey in order to apply as a mentor for the 2022-2023 Minnesota Mentor Program. 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 a protégé in the MMP, please utilize the Minnesota Mentor Program - Protege Application.

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

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* 1. Name (First and Last)

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* 2. Email

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* 3. Phone/Text Number

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* 4. 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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* 5. Current position/title

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* 6. School District

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* 7. 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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* 8. Indicate the categorical area of 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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* 9. Have you participated as an MMP mentor in past years?

Yes (Please specify which school year/s.)

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* 10. 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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* 11. Minnesota File Folder Number: Minnesota Educator License Lookup

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* 12. How many years of teaching experience have you completed as of June 2022?

(A minimum of 5 years experience is required to be a mentor in MMP.)

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* 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.)

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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* 14. 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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* 15. 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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* 23. 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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* 24. 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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* 25. 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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* 26. 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

2022-2023 Mentor Application for Minnesota Mentor Program (MMP)

Mentor Application

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* 1. Name (First and Last)

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* 2. Email

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* 3. Phone/Text Number

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

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* 5. Current position/title

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* 6. School District

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

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* 8. Indicate the categorical area of license for which you are applying to be a mentor:

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

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

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* 11. Minnesota File Folder Number: Minnesota Educator License Lookup

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* 12. How many years of teaching experience have you completed as of June 2022?(A minimum of 5 years experience is required to be a mentor in MMP.)

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* 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.)

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

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* 15. 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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* 16. Birth-2 years (Part C - Early Childhood)

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* 17. Ages 3-5 years (Preschool)

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* 18. Kindergarten - Grade 5 (Elementary School)

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* 19. Grades 6 - 8 (Middle School)

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* 20. Grades 9 - 12 (High School)

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* 21. Post-school/Transition Programs - Up to Age 21

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* 22. Self-Reflection as a Mentor: Consider these statements as they apply to you as a mentor.

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* 23. 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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* 24. 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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* 25. 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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* 26. 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.)

* 12. How many years of teaching experience have you completed as of June 2022?

(A minimum of 5 years experience is required to be a mentor in MMP.)

* 15. 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.

* 24. 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.

* 26. 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.)