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Emeritus Assembly Mentor Information
Gathering Information from Prospective Mentors for Early Career Educators
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* Indicates required question
What is your First Name
*
Your answer
What is your Last Name
*
Your answer
In what state do you live?
*
Your answer
What is your preferred email address?
*
Please enter the address you'd like to appear on our website for teachers to contact you.
Your answer
What is your preferred phone number?
Please include ten-digit phone number.
Your answer
In what time zone do you live?
*
Choose
Eastern Standard
Central Standard
Mountain Standard
Pacific Standard
Alaska Standard
Hawaii Standard
Other (if other please specify below)
If none of the time zones above, please specific your time zone here.
Your answer
What is your professional education experience?
*
Please check areas in which you feel competent mentoring.
Pre-School
Elementary School
Middle School
High School
Two-Year College
Four Year College
Graduate School
English Language Learners
Multicultural/Ethnic Student Body
Required
What is your leadership experience?
Please check those experiences about which you are confident mentoring.
Administration (Principal, Vice Principal)
Counseling
Department Chair
Grade Level Team Leader
District Curriculum Co-ordinator
State Department Educator
Other (Please specify below)
If you've held other leadership position(s) than those listed above, please specify here.
Mention those you'd feel competent as a mentor.
Your answer
In what KIND(S) of schools have you had professional educational experience?
*
Please check those kinds of schools about which you feel confident mentoring.
Charter
Department of Defense
Ex-Urban (Outside major city, but not suburban)
Independent
International (outside the United States)
International Baccalaureate
Parochial
Private
Public
Urban
Other (specific below)
Required
If you have had experience in a different kind of school than those listed above, please specify here.
Your answer
Did you coach, sponsor or supervise an extra-curricular team, club, or activity?
*
Check those about which you are confident mentoring.
Choose
Athletic Team (specify in "Other" below)
Drama Coach
Literary Magazine
Newspaper
Speech Coach
Yearbook
Other
None
What specific kind of sport or different kind of club or activity did you coach or sponsor?
Specify here.
Your answer
Do you know other retired ELA educators who may be interested in joining the Emeritus Assembly?
Please list their full names and email contact information in space below.
Your answer
Please share names of current college professors who may be willing to share our Emeritus Assembly offer to mentor with their current or past students.
Please tell them about our program and list full names and email addresses,
Your answer
Do you know current ELA leaders who would be interested in sharing our Emeritus Assembly offer to mentor members of their department or team?
Please tell them about our program and also list full names and email contact information.
Your answer
Do you have special skills that will help us make this mentoring initiative more efficient and/or effective?
Please briefly share your idea here and let us know when and how we can contact you to explore further.
Choose
Web Design
Making Telephone Calls
Writing Letters
Analyzing Data
Other (please specify in space below)
What other ways can you help make this Emeritus Assembly/Early Career Educators Mentoring initiative more effective?
Please mention those areas you're willing to take on yourself.
Your answer
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