2022-2023 Protégé Application for Minnesota Mentor Program (MMP)

Protégé Application

Please complete this form to apply as a protégé for the 2022-2023 Minnesota Mentor Program. If you have any questions, please contact Ann Mayes at Ann.Mayes@metroecsu.org or (612) 638-1527.

If you would like to apply as an MMP mentor, please utilize the Minnesota Mentor Program - Mentor Application.

***Please share the following link with your supervisor so they can submit the Required Supervisor Recommendation on your behalf: Required: MMP Supervisor Recommendation ***

Question Title

* 1. Name (First and Last)

Question Title

* 2. Email

Question Title

* 3. Phone/Text Number

Question Title

* 4. Your home mailing address for Minnesota Mentor Program-related materials to be sent to (not school or district offices):

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Question Title

* 5. Position / Title for Fall 2022

Question Title

* 6. School District

Question Title

* 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)

Question Title

* 8. Have you participated as an MMP protégé in past years?

Yes (Please specify which year/years)

Question Title

* 9. Indicate the categorical area of license for which you are applying to be 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)

Question Title

* 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, in multiple settings. Check all that apply.

As a resource teacher, you might serve students who have both Setting I and Setting II on their IEPs, depending on the amount of time they're in the general education classroom. 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)

Question Title

* 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)

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

Question Title

4 - Very experienced

Question Title

* 20. Describe why you are requesting support from a mentor and what you hope to gain from participating in the Minnesota Mentor Program as a protégé.

For experienced teachers, explain what area of your field for which you are seeking mentorship. For example, If you've never taught preschool children and now have a new student on your caseload who's in that age range. Or, you have a blind student and have not taught Braille before.

Question Title

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

Question Title

* 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 his/her name below. Note: This applies only if you are not already currently matched with the same mentor in your district.

Question Title

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

This is required for all 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.)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

2022-2023 Protégé Application for Minnesota Mentor Program (MMP)

Protégé Application

Question Title

* 1. Name (First and Last)

Question Title

* 2. Email

Question Title

* 3. Phone/Text Number

Question Title

* 4. Your home mailing address for Minnesota Mentor Program-related materials to be sent to (not school or district offices):

Question Title

* 5. Position / Title for Fall 2022

Question Title

* 6. School District

Question Title

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

Question Title

* 8. Have you participated as an MMP protégé in past years?

Question Title

* 9. Indicate the categorical area of license for which you are applying to be a protégé:

Question Title

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 15. Ages 3-5 years (Preschool)

Question Title

* 16. Kindergarten - Grade 5 (Elementary School)

Question Title

* 17. Grades 6 - 8 (Middle School)

Question Title

* 18. Grades 9 - 12 (High School)

Question Title

* 19. Post-school/Transition Programs - Up to Age 21

Question Title

Question Title

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

Question Title

* 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 his/her name below. Note: This applies only if you are not already currently matched with the same mentor in your district.

Question Title

* 23. Please upload a copy of your current resume. **This is required for all 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. Please upload a copy of your current resume.

This is required for all 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.)