Indiana CTO Council Mentor Application Cadre 8 2020-2021
We are excited to partner with the Indiana Department of Education to provide leadership development opportunities for Hoosier K12 leaders at the crossroads of technology and learning. Our desire is to increase professional knowledge, promote collaboration, and offer mentoring and leadership options to the K12 technology leaders of our state. This group may include Technology Directors and Coordinators, eLearning Specialists and Curriculum staff with a desire to become district leaders, as well as Assistant Superintendents and others who desire to mentor new Indiana IT leaders with their knowledge and experience. Please complete the form below for consideration as a mentor. Forms for our CTO2B cadre 8 must be completed by August 14th, 2019. Notification will be August 17th with a mandatory launch meeting meeting for all participants on Friday August 28th at the PLTW headquarters on the north side of Indy. This form is for MENTORS.



This form is for Mentors.
First Name *
Last Name *
Phone number *
(xxx) xxx-xxxx
Email *
Address *
City *
Zip Code *
School District or Organization Name *
Mentors mst be from an Indiana CoSN member organization
Membership type *
Corporation ADM *
List "N/A" if not applicable
Your Title *
Years in position *
Years in K12 leadership *
Time you have spent in other K12 leadership positions other than you current role.
Certified Educational Technology Leader (CETL) *
Please indicate on a scale of 1-5 your sense of interest in teaching Essential Skills to a CTO2be: *
1 Low Interest
2
3
4
5 High Interest
Leadership and Vision
Strategic Planning
Ethics and Policy
Instructional Focus & PD
Team Building & Staffing
Stakholder Focus
IT Management
Communications Systems Management
Business Management
Data Management
Please rate yourself using the following continuum of your skillsets in each Essential Skill area below. *
1 Growth Area 
2
3
4
5 Strength Area
Leadership and Vision
Strategic Planning
Ethics and Policy
Instructional Focus & PD
Team Building & Staffing
Stakholder Focus
IT Management
Communications Systems Management
Business Management
Data Management
Program Commitment: I understand that working as a mentor can be an extremely rewarding experience, and I appreciate that the beneficial outcomes require a professional commitment to sharing openly, communicating effectively, and learning from each other. I agree to make a personal commitment of the time to attend training and have approval from my supervisor for participation in the program. *
Please also download and sign the signature form along with your Superintendent and submit with signatures.
Please write a short explaination on why you are interested in the role of Mentor. *
(100-200 words)
Please detail your journey into your current role as a K12 educational technology leader with reflection on your current responsabilities. *
(200-400 words)
Submit
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