Mentorship Program Application Form

I am applying as a (pick only one): New Mentor with five or more years of successful teaching Mentor with previous Mentorship Program experience Protégé who is new to the district Protégé who is new to a school Protégé who has a new teaching assignment Name   School   My teaching assignment is (please be specific): Optional Information: I can be contacted at home at (phone number or e-mail address) As a Mentor, I would be willing to be partnered with more than one protégé. I have identified the following person/s to be my partner: Name School Teaching Assignment Name School Teaching Assignment I would like to be teamed with a teacher with the following assignment: Grade Level  or  Subject Area  or  Principal Recommendation I have discussed this program with my principal (name)  and she/he recommends my participation. For further information, contact Karen Keats Whelan, Mentorship Program Coordinator at 498-8794.