Application to serve as Mentor

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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.

What is your last name? *

What is your first name? *

Email: *

Years of formal, district-contracted, full-time teaching experience: *

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) *

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) *

Marching Band

Concert Band

Jazz Band

Musical Pit

Small Instrumental Ensembles

Beginning Band

Other:

Required

My current teaching environment is best described as: *

Urban

Suburban

Rural

In which region of the country are you located? *

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!) *

Yes

What is the name of your school (including HS, MS, Elem, University)? *

What is the name of your school district? (Please include district #) *

What type of degree(s) and/or certifications do you hold? *

Which categories describe your top three strengths? *

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) *

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? *

Yes

Scheduling: Please choose all that apply. *

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? *

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:

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