Connecticut: Networking Fellowship Mentor Application
Complete this application if you would like to be a mentor in the Connecticut Proficiency Fellowship. (There is a separate application for "mentees." There will be a limited number of places for these mentors.)

Novice teachers and experienced teachers will be placed together in networking groups.
*Applications are due by 6/30.

For more information about this activity, please click here: http://bit.ly/networkingctwl

What is your first and last name? *
Your answer
School/institution *
Your answer
Preferred email address *
Your answer
Preferred mailing address *
Address (street, town, state, zip code) *
Your answer
Phone number *
Your answer
Current position *
Your answer
How long have you held this position? *
Your answer
Name of supervisor and mailing address *
Your answer
Year of teaching experience *
Your answer
What language(s) and level(s) have you taught? *
Your answer
What language and level would you prefer to mentor? *
Your answer
School, type, size (number of total student body, number of students studying languages, number of languages offered, number of language teachers), location (rural, urban, suburban): * *
Your answer
Please describe any previous experience you may have mentoring new teachers. * *
Your answer
Program participants are expected to meet face to face and also correspond electronically. Using virtual software, small groups of participants will connect virtually in between face-to-face meetings. Which topics would you feel most comfortable with if you were to lead such a discussion? * *
Your answer
PERSONAL STATEMENT: Please respond to each of the following questions: (this statement will be used for matching mentors and mentees.) 1. Why are you interested in participating in this program? 2. In what ways and specific areas do you feel you can help a new educator? 3. What are the strengths you would bring to mentoring? 4. What challenges did you face in your career and how did you overcome them? *
Your answer
Please check this box to indicate that, if you are accepted into the program, you pledge to attend our initial Meet-and-Greet on Sunday, 10/20 at 2 p.m. You are invited to stay the rest of the day, for free. *
Meet and greet location is at the Cromwell Red Lion Inn (formerly the Radisson)
Required
Please check this box to indicate that, if you are accepted into the program, you will participate in a closed Facebook group for fellowship participants. *
Required
Is there anything else you would like to add?
Your answer
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