I have read the mentoring handbook and am interested in being considered for the position of mentor. I understand that I will need to attend the mentor training program and that some of my mentoring responsibilities may take place beyond the school day.

Directions: Forward the completed form by July 15, 2005 to the

Mentoring Program Committee, 251 Stonehaven Road, Fall River, MA 02723

Name: __________________________________________________________________

Summer Telephone Number: _________________________________________________

Subject or Vocational Area(s):________________________________________________

Years of Teaching in District: _________________________________________________

Other Educational Experience: ________________________________________________

Certification(s)/License(s) Held:________________________________________________

Previous Mentoring Experience:________________________________________________

Why do you want to be a mentor?

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What special skills, traits, or training would you bring to the process of mentoring new teachers?

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How are you keeping current in academic curriculum or vocational skills?

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Signature: ___________________________________________ Date: ________________