Partners in Technology - Mentor Registration
This form is for community members in technology fields interested in being mentors in Normal Public Library's Partners in Technology Pilot Program.  

At this time, Normal Public Library is looking for mentors employed in, retired from, or studying programs in technology related fields.

The program will run for eight weeks, beginning the week of February 3, 2020. Mentors will be selected and paired based on availability, area of knowledge, and number of applicants.

Mentors will be paired with participants ages ten to fourteen with an interest in expanding their familiarity and knowledge of technology through one-on-one learning. Pairs will meet weekly at the library at an agreed upon time for 1 hour (60 minute) sessions. During these sessions, pairs will have access to a range of library and open-source, free resources to aid their technology exploration. Pairs are encouraged to spend at least 15 minutes of their weekly sessions engaging in "unplugged" activities that encourage computational thinking skills.

This program is part of the Libraries Ready to Code Grant funded by The American Library Association and sponsored by Google. Participants in Partners in Technology may be asked to complete surveys regarding the program. Survey findings may be presented at conferences or for grant related purposes.

All are encouraged to apply! Those not chosen to participate at this time will have the option of participating in future Partners in Technology programs.

Contact Jane Jankowski - Children's Technology and Programming Librarian with any questions.
jane@normalpl.org 
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First Name *
Middle Initial *
Last Name *
Email *
Address *
City *
State *
Zip Code *
Availability
Mark all days/times that you would be available to start your weekly session. *
3:00 - 3:45
4:00 - 4:45
5:00 - 5:45
6:00 - 6:45
7:00 - 7:45
unavailable this day
Monday
Tuesday
Wednesday
Thursday
Technology Mentorship Information
I consider myself to have a growth mindset, meaning I am willing to learn alongside my student focusing on the process of learning over the product. I understand that I do not have to be an expert in all areas of coding, robotics, and circuitry, but am willing to expand my knowledge. *
How comfortable are you working with/learning to work with coding concepts and tools - including, but not limited to code.org, PythonAnywhere, HTML/CSS? *
not at all
very comfortable
How comfortable are you working with/learning to work with robotics concepts and tools - including, but not limited to LEGO WeDo Robotics, K'NEX Robotics, Ozobots? *
not at all
very comfortable
How comfortable are you working with/learning to work with circuitry and hardware concepts and tools - including, but not limited to MaKey MaKey, Little Bits, Snap Circuits, Arduino, Raspberry Pi? *
not at all
very comfortable
Current Employer and Position or University/College and area of study:
Previous Volunteer Experience:
Languages Spoken:
Please share why being a Partners in Technology Mentor is of interest to you. *
Are you fulfilling hours for an organization?
Clear selection
If yes, please list number of hours and completion deadline.
Please describe your technology related experience. This may include your work experience and/or hobbies. *
Please describe your experience working with children ages 10 to 14. *
If you have a favorite free or open-source technology resource, please share below:
If I am not selected, I would like to be considered for future Partners in Technology programs. *
I understand that, if selected, I must attend one of the Partners in Technology Mentor Orientation Sessions that will take place in early January, or make other arrangements to meet with the Technology and Programming Children's Librarian - Danny Rice, before meeting with my partner. *
Background
Have you ever been dismissed or asked to resign from any position for reasons other than a disability? *
If yes, please explain:
Have you ever been convicted of a crime? *
If yes, please explain:
A background check is required for all library volunteers. Are you willing to submit to one? *
For the purposes of the background check, I agree to provide the following information. I understand that this information will only be used for those selected as mentors. Participation as a mentor is contingent on a successful background check. *
Gender *
Race *
Date of Birth *
MM
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Confidentiality Agreement
Please read the Confidentiality Agreement carefully and select yes or no.
I understand that it is the policy of the Normal Public Library to protect the privacy of those who use the library. I agree to hold all information about patrons in complete confidence and to access this information only in the course of performing my volunteer assignments. In addition, I understand that a breach of confidentiality is grounds for dismissal from the library's Partners in Technology Program. *
Terms of Acceptance and Signature
I hereby certify that the information provided above is true and complete to the best of my knowledge. I understand that I will not be paid as a mentor.   I understand that I will serve as needed by the Normal Public Library and my assignment may end at any time, with or without cause. I understand that submitting this application does not guarantee my spot as a mentor. I understand that a background check is required and I am willing to submit to one. *
Electronic Signature - Please type your First and Last Name *
I understand that signing this document electronically constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance.
Clear selection
Date *
MM
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DD
/
YYYY
Submit
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