2025-2026 Protégé Application for Minnesota Mentor Program (MMP)

Protégé Application

Please complete this form to apply as a protégé for the 2025-2026 Minnesota Mentor Program. If you have any questions, please contact Ann Mayes at Ann.Mayes@brightworksmn.org or (612) 638-1527.

***Please share the following link with your supervisor so they are aware you are taking extra steps and requesting a low-incidence disability-specific mentor and can submit the Required Supervisor Recommendation on your behalf: 2025-2026 MMP Supervisor Recommendation for Protégés ***

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* 1. Your name (First and Last)

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* 2. School Email

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* 3. Summer Email (include the email address where you can receive MMP updates, announcements, pairings in June, July and August)

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* 4. Phone/Text Number (to share with your mentor)

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* 5. Your home mailing address for Minnesota Mentor Program-related materials to be sent to:

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

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* 6. School District (where you will be/are employed)

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* 7. Indicate which region of the state that you teach in.

NW Minnesota: Regions 1 & 2 - Counties: Beltrami, Clearwater, Hubbard, Kittson, Lake of the Woods, Mahnomen, Marshall, Norman, Pennington, Polk, Red Lake, Roseau)

NE Minnesota (Region 3 - Counties: Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, St. Louis)

W Minnesota (Region 4 - Counties: Becker, Clay, Douglas, Grant, Otter Tail, Pope, Stevens, Traverse, Wilkin)

Central Minnesota (Regions 5 & 7 - Counties: Benton, Cass, Chisago, Crow Wing, Isanti, Kanabec, Mille Lacs, Morrison, Pine, Sherburne, Stearns, Wright)

SW Minnesota (Regions 6 & 8 - Counties: Big Stone, Cottonwood, Jackson, Kandiyohi, Lac Qui Parle, Lincoln, Lyon, McLeod, Meeker, Nobles, Pipestone, Redwood, Renville, Rock, Swift, Yellow Medicine)

South Central Minnesota (Region 9 - Counties: Blue Earth, Brown, Faribault, LeSueur, Martin, Nicollet, Sibley, Waseca, Watonman)

SE Minnesota (Region 10 - Counties: Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, Winona)

Twin Cities Metro (Region 11 - Counties: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington)

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* 8. Indicate the categorical area of low-incidence disability for which you are requesting a mentor as a protégé:

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (B/VI)

Deaf/Hard of Hearing (D/HH)

Developmental and Cognitive Disabilities (DCD)

Physical/Health Disabilities (PHD)

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* 9. Special Education Teaching Position for 2025-2026

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* 10. In what placement setting(s) do or will you serve? (The placement setting number is usually listed on the first page of your students' IEPs.)

Examples of multiple checkboxes selected:

As an itinerant teacher, you might serve students through a special education cooperative or intermediate school district, in multiple settings. Check all that apply.

As a resource teacher, you might serve students in multiple settings. Check all that apply.

This information will help match you with a mentor who might have similar experiences.

I am itinerant teacher and provide services in the following settings:

Setting I - Students receive special education services outside the regular education classroom for less than 21 percent of the day.

Setting II - Students receive special education services outside the regular education classroom, typically a resource room, for 21 percent to 60 percent of the school day.

Setting III - Students are outside of the regular education classroom for more than 60 percent of the day.

Setting IV - Students receive special education services at separate school facilities for more than 50 percent of the school day.

Setting V - Students receive special education services at a private, separate day school for more than 50 percent of the school day.

Setting VI - Students receive special education services at a public residential facility for more than 50 percent of the school day (e.g., MN State Academies).

Setting VII - Students receive special education services at a private residential facility for more than 50 percent of the school day.

Setting VIII - Special education services are delivered in a homebound or hospital or home-based setting.

Other (please specify)

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* 11. Indicate which Minnesota teaching license(s) you currently hold (at the time of this application).

Autism Spectrum Disorders (ASD)

Blind/Visually Impaired (B/VI)

Developmental and Cognitive Disabilities (DCD)

Deaf/Hard of Hearing (D/HH)

Physical/Health Disabilities (P/HD)

Academic and Behavioral Strategies (ABS)

I am applying for a teaching license in the following field:

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* 12. Minnesota License File Folder Number:

(If you don't know your file folder number, you can find it at Minnesota Educator License Lookup.)

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* 13. Indicate your License Tier. Find the Tier on your File Folder Number.

Tier 1

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* 21. What challenges do you anticipate you will face as a protégé?

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* 22. If you know teacher in your district or region who will apply to be an MMP mentor, and you two would like to be matched together, please write their name below. Note: This applies only if you are not already currently matched with the same mentor in your district.

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* 23. Have you sent the 2025-2026 MMP Supervisor Recommendation for Protégés link to your current or new supervisor, special education director, or special education coordinator to complete on your behalf?

If not yet, we encourage you to reach out to them and ask them to complete it for you.

Yes

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* 24. Have you participated as an MMP protégé last year or in past years?

Yes (Please specify which year/years)

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* 25. Please upload a copy of your current resume.

This is required only for new protégés.

(Note. If you participated as an MMP protégé last year or the year before, and your resume has not changed, you do not need to upload your resume.)

2025-2026 Protégé Application for Minnesota Mentor Program (MMP)

Protégé Application

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* 1. Your name (First and Last)

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* 2. School Email

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* 3. Summer Email (include the email address where you can receive MMP updates, announcements, pairings in June, July and August)

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* 4. Phone/Text Number (to share with your mentor)

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* 5. Your home mailing address for Minnesota Mentor Program-related materials to be sent to:

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* 6. School District (where you will be/are employed)

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* 7. Indicate which region of the state that you teach in.

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* 8. Indicate the categorical area of low-incidence disability for which you are requesting a mentor as a protégé:

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* 9. Special Education Teaching Position for 2025-2026

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* 11. Indicate which Minnesota teaching license(s) you currently hold (at the time of this application).

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* 12. Minnesota License File Folder Number:(If you don't know your file folder number, you can find it at Minnesota Educator License Lookup.)

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* 13. Indicate your License Tier. Find the Tier on your File Folder Number.

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* 14. Birth-2 years (Part C - Early Childhood)

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* 15. Ages 3-5 years (Preschool)

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* 16. Kindergarten - Grade 5 (Elementary School)

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* 17. Grades 6 - 8 (Middle School)

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* 18. Grades 9 - 12 (High School)

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* 19. Post-school/Transition Programs - Up to Age 22

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* 21. What challenges do you anticipate you will face as a protégé?

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* 22. If you know teacher in your district or region who will apply to be an MMP mentor, and you two would like to be matched together, please write their name below. Note: This applies only if you are not already currently matched with the same mentor in your district.

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* 23. Have you sent the 2025-2026 MMP Supervisor Recommendation for Protégés link to your current or new supervisor, special education director, or special education coordinator to complete on your behalf? If not yet, we encourage you to reach out to them and ask them to complete it for you.

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* 24. Have you participated as an MMP protégé last year or in past years?

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* 25. Please upload a copy of your current resume. **This is required only for new protégés.**(Note. If you participated as an MMP protégé last year or the year before, and your resume has not changed, you do not need to upload your resume.)

* 12. Minnesota License File Folder Number:

(If you don't know your file folder number, you can find it at Minnesota Educator License Lookup.)

* 23. Have you sent the 2025-2026 MMP Supervisor Recommendation for Protégés link to your current or new supervisor, special education director, or special education coordinator to complete on your behalf?

If not yet, we encourage you to reach out to them and ask them to complete it for you.

* 25. Please upload a copy of your current resume.

This is required only for new protégés.

(Note. If you participated as an MMP protégé last year or the year before, and your resume has not changed, you do not need to upload your resume.)