Mentor Registration Form

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Thank you for your interest in being a Mentor to a new Special Education Administrator. This is a two year commitment. You will be expected to meet with your mentee throughout the year for a minimum of 10 hours. Your mentee will be responsible for keeping the log and submitting it at the end of each school year. If you have any questions please email Gayle Willey, Executive Director gayle.willey@mo-case.org

Email *

Name

School District

Title

Contact email address

Contact phone number

Mailing address

Number of years as a Special Education Administrator

Please check the areas in which you have experience as a Special Education Administrator.

Hiring/Evaluations

Finance/Budgets

Curriculum and Instruction

Interventions

Evaluations/Assessments

Scheduling

Early Childhood Special Ed

Professional Development

Administrator Collaboration

Federal Programs and/or 504

Are you currently mentoring anyone?

Yes

Clear selection

What LASE group do you attend?

Are you willing to mentor someone outside of your geographical area? (You could meet face-to-face or virtually)

Yes

Clear selection

Are you willing to take more than one mentee if you can meet over Zoom?

Yes, I'd be glad to.

No, I'd like to just have one mentee at a time.

Clear selection

Submit

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