Mentor Teacher Update Form

2. Your First Name *This question is required.

3. Your Preferred Name *This question is required.

4. Your Last Name *This question is required.

5. Your email address. For Relay students, this is your @student.relay.edu email. *This question is required. This question requires a valid email address.

6. Student ID Number *This question is required.

6. Please enter the student's full name as it currently appears in Relay's systems. *This question is required.

6. Please enter the student's email address as it currently appears in Relay's systems.

6. Student's SIS Link

6. What is the student's campus/location? *This question is required.

7. Please provide the name of the school at which the Relay student is currently employed. *This question is required.

8. What is the new mentor teacher's first name? *This question is required.

9. What is the new mentor teacher's last name? *This question is required.

10. What is the new mentor teacher's email address? *This question is required. This question requires a valid email address.

11. What valid, state-issued teaching certificate/license does the new mentor teacher hold? *This question is required.

12. What is the new mentor teacher's IEIN? *This question is required.

12. How many years of experience does the Mentor Teacher have? Please note that the Mentor Teacher must have at least three years of full-time teaching experience in the previous 10 years.

12.
What is the estimated amount of time the mentor will devote to advising and assisting the Relay student each week?

If no one on campus meets all 3 requirements, select a mentor teacher that most closely fits the requirements. All mentors must have demonstrated results with students, even if they are not currently certified or have fewer than 3 years of teaching experience. If you have selected a mentor teacher who does not meet the certification or years of experience requirement, please explain why the mentor teacher was assigned.

12. How many years of satisfactory, certified teaching experience does the Mentor Teacher have in the subject area? *This question is required.

12. Does the Mentor Teacher have at least 1 year of certified teaching experience in the school where the Relay student is placed? *This question is required.

12. Has the Mentor Teacher been selected as part of a PDE approved induction program? *This question is required.

12. How many years of experience does the Mentor Teacher have (minimum 3 years required)? *This question is required.

12. Please select the level of overall effectiveness of the Mentor Teacher for the prior school year. Please note that a teacher with a rating of less than above expectations is not eligible to be a Mentor Teacher. *This question is required.

12. What position does the new mentor teacher hold at the school site? *This question is required.

13. How many years of experience does the new mentor teacher have?

13. If you answered "Other" please clarify the mentor teacher's position at the school site.

13. What grade level(s) does the new mentor teacher teach, if at all? *This question is required.

14. What content area(s) does the new mentor teacher teach, if at all? *This question is required.

15. Please provide the authorized school administrator's name.

15. Please provide the authorized school administrator's email. This question requires a valid email address.