Susquehanna Valley Central School District

TEACHER MENTOR APPLICATION

Due Date: June 2, 2008

ATT: Assistant Superintendent

Name:

Building:

__	Please check here if you were a Mentor for the current school year, and wish to Mentor for the next school year. Enter your name and building only. (You do not have to complete the remainder of the application.)

TEACHING EXPERIENCE

Please list certification areas and status of certification:

Certification Area:	Status:
Certification Area:	Status:
Certification Area:	Status:

Grades / subjects taught and number of years:

GRADE

SUBJECT(S)

NO. OF YEARS

Describe one research-based instructional strategy and classroom management strategy that you believe new teachers should understand:

Describe what communication skills that you believe a new teacher should demonstrate:

Explain how you would establish positive, interpersonal relationships with one of the following: staff, parents, or administrators:

SVCSD – Teacher Mentor Application Pg. 2

Describe how you have implemented recent professional development in which you have participated:

Describe any leadership roles that you have had which especially qualify you for your role as a mentor:

Please describe why you want to be a mentor:

List names of two references who can attest to your professional qualifications as a mentor.

(see attached forms)

1.

2.

I agree to participate in professional development opportunities provided by the district, complete all responsibilities of the role of the mentor, and maintain confidentiality of the program.

SIGNATURE OF APPLICANT

DATE

Application must be received in the SV District office NO LATER than June 2, 2008

Mail to: Assistant Superintendent, Susquehanna Valley CSD, P.O. Box 200, Conklin, NY 13748