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Application to serve as Mentor
Thank you so much for nominating yourself as a mentor. Please note, that participation in this program is based on the needs of our mentee regions. If we do not need you at this present time, we will keep your information in our database. Please expect a response from us in 10 business days. Thank you for taking this initiative and we look forward to growing the mentorship program.
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* Indicates required question
What is your last name?
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Your answer
What is your first name?
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Your answer
Email:
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Your answer
Years of formal, district-contracted, full-time teaching experience:
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Less than a year
1-3 years
3-5 years
5-8 years
8-15 years
15 + years
Which of the following levels are you currently working with? (Please choose all that are applicable)
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Elementary (K-5)
Middle School (6-8)
High School
Retired Band Director
Administrator
College/University
Other:
Required
Areas of current experience: (please choose all that are applicable)
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Marching Band
Concert Band
Jazz Band
Musical Pit
Small Instrumental Ensembles
Beginning Band
Other:
Required
My current teaching environment is best described as:
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Urban
Suburban
Rural
In which region of the country are you located?
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Eastern Division [CT, DE, ME, MD, MA, NH, NJ, NY, PA, RI, VT]
North Central Division [IL, IN, IA, MI, MN, NE, ND, OH, SD, WI]
Northwestern Division [AK, ID, MT, OR, WA, WY]
Southern Division [AL, FL, GA. KY, LA, MS. NC, SC, TN, VA, WV]
Southwestern Division [AR, CO, KS, MO, NM, OK, TX]
Western Division [AZ, CA, HI, NV, UT]
Do you have previous experience as a mentor? (Please note that previous experience is not required!)
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Yes
No
What is the name of your school (including HS, MS, Elem, University)?
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Your answer
What is the name of your school district? (Please include district #)
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Your answer
What type of degree(s) and/or certifications do you hold?
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Your answer
Which categories describe your top three strengths?
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Rehearsal Strategies
Lesson Planning and Score Study
Specific Instrument Pedagogy
Classroom Management
Curriculum Development
Creating Assessments
Incorporating Technology
Concert/Performance Preparation and Traveling for Performance
Recruitment Techniques
Band Booster or Parent Organizations
Techniques for Building Relationships
Fundraising and Building Financial Support (Donations)
Instrument Repair
Strategies to be a Successful Traveling Teacher
Budgeting
Grant Writing
Scheduling
Administrative Needs
Additional Professional Development
Mentorship Evaluations
Graduate Programs
Student Learning Outcomes (SLO)
Incorporating Common Core
As a mentor, what would be the most effective way for you to give feedback? (please check all that apply)
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Email
Phone
Video/Audio Review
On-Site Observations
In Person Meetings
Other:
Required
Do you have experience with video conferencing services such as: FaceTime, Skype, or Google Hangouts?
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Yes
No
Scheduling: Please choose all that apply.
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I have experience teaching homogeneous sectionals.
I have experience with mixed instrument sectionals.
I have experience with classes that are split by grade-level.
I have experience with classes that are split by ability-level.
I have experience as a traveling teacher.
Required
Where did you hear about the Title 1 Mentorship Program?
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Referred by a friend or colleague
Referred by an administrator
Social media
National Band Association (NBA)
Nafme (National Association for Music Education)
CBDNA (College Band Directors National Association)
Music for All
Other:
Additional Comments:
Your answer
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