Mentor Application: 2024-2025

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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.

Preferred Email for All Induction Communication *

First Name ONLY *

Last Name ONLY *

Preferred Pronouns *

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 *

Race/Ethnicity *

American Indian or Alaska Native

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

Black or African American

Hispanic/Latinx (of any race)

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 *

Pre-K/TK

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

Other

Required

Subject(s)/Content taught (Middle & High School Only)

Do you have ECE (Early Child Education) Units and/or Preschool/TK experience? If so, please explain.

How many years have you been teaching? *

PROFESSIONAL INFORMATION

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

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? *

Butte Teacher Induction Program Mentor

I am a new mentor for the Butte Teacher Induction Program. *

Yes

No, I have been a mentor before for the Butte Teacher Induction Program.

I was a candidate in the Butte Teacher Induction Program. *

Yes

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