Mentor Application: 2021-2022

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Welcome to the Butte Teacher Induction Program! We are extremely excited to embark upon this learning journey with you as you share your educational expertise with a new teacher and continue to grow as a professional leader. We appreciate you taking the time to complete this form as this information will ensure a smooth transition into our mentoring program and provide us with needed information as we match mentors and candidates.

Please do not hesitate to contact us if you have any questions or concerns as we are here to support you.

Tracey Allen
Senior Director of Professional Learning
tallen@bcoe.org
530-532-5730

Email *

Applicant Information

The following information is vital for our mentoring assignment process for the Butte Teacher Induction Program. Please complete the entire form.

First Name ONLY *

Last Name ONLY *

Mailing Address *

City *

Zip Code *

Phone Number *

Demographic Information

Assembly Bill 677 requires the Commission on Teacher Credentialing (CTC) to collect gender identity and sexual orientation information in the course of regular collection of demographic data.

Gender *

Sexual Orientation *

Race/Ethnicity *

American Indian or Native American

Asian (Chinese, Japanese, Korean, Vietnamese, Asian Indian, Laotian, Cambodian, Filipino, Hmong)

Black or African American

Hispanic/Latino

Native Hawaiian or Pacific Islander (Guamanian, Samoan, Tahitian)

Two or More Races

White

Decline to State

Required

Employment Information

Name of School District *

Name of School Site *

Principal/Site Administrator *

Principal/Site Administrator's Email *

Current Grade Level/Assignment Type *

Grade Level(s)/Subject(s) taught previously

How many years have you been teaching? *

The name(s) of the candidate(s) you will be supporting this year, if known.

Professional Information

Please check all the boxes that apply to you: *

I hold a valid California Clear Credential.

I have a minimum of 3 years of successful teaching experience supported by satisfactory evaluation(s).

I am familiar with the California Standards for the Teaching Profession.

I am open to learning and growing as a professional educator and mentor.

I have the capacity to connect my participating teacher with a variety of resources.

Required

I hold the following credential(s): *

I hold a Multiple Subject Credential.

I hold a Single Subject Credential

I hold an Education Specialist Credential: Mild/Moderate.

I hold an Education Specialist Credential: Moderate/Severe.

I hold an Education Specialist Credential: Other

Required

If you hold a Single Subject Credential or Education Specialist: Other Credential, please indicate the subject/specialty area.

Which university issued your teaching credential? *

Which college/university did you attend for your undergraduate work? *

Mentor Reflection Questions

Please answer the following questions briefly, but thoughtfully.

Describe any experience you have had in the area of supervision and/or mentoring. This may include work with student teachers, team/grade level/department lead, mentoring, or similar roles. *

Why are your interested in becoming a mentor? *

Please describe your skills and qualifications for the role of mentor. You do not have to address every item, rather use them as a reference frame for how you are qualified to offer the necessary support to a new teacher (i.e. lesson planning, instructional strategies, communication, leadership experience, coordination of resources, assessment tools, reflective teaching process, time management, Professional learning communities, etc.) *

If you are a new mentor to the Butte Teacher Induction Program, please email a letter of recommendation from your current site administrator or superintendent to tallen@bcoe.org

Mentor Assurance Statement

I would like to be considered for a Mentor position with the Butte Teacher Induction Program. I understand that I will be required to attend mentor trainings, meet with my Candidate weekly for an hour, complete required paperwork, and attend monthly network meetings with my candidate. I also understand that by fulfilling my mentoring obligations, I will be paid $1,800 per candidate, inclusive of benefits.

I understand and agree to the above Mentor Assurance Statement. *

Yes

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