Mentor Teacher Application

First Name

Last Name

District Email

School District

BISD Campus Name

CSISD Campus Name

Grade

Content Area

Other content

List specific content taught (e.g. Algebra, Biology, US History, etc.)

Language in which instruction is given

English only

Spanish only

Both English and Spanish

Total years experience

Have you hosted a TAMU student before?

Yes

No

Indicate number of days/week you are willing to host Aggie students in your classroom

Indicate best time time to host student/s

ALL DAY

Mornings ONLY

Afternoons ONLY

Unsure at this time

Qualifications for hosting a clinical teacher

I confirm that I meet the outlined qualifications

To be considered to host a clinical teacher you meet the following required cooperating teacher guidelines:

3+ years teaching experience;
current Texas teaching certification (in primary certification category of clinical teacher);
accomplished educator (as shown by student learning);
willingness to complete cooperating teacher training and report clinical teacher’s progress to supervisor;
commitment to guide, assist and support clinical teacher in planning/classroom management/instruction/assessment/working with parents/obtaining materials/district policies.

List your current teaching certification(s)

For verification, visit https://secure.sbec.state.tx.us/SBECONLINE/virtcert.asp

ESL Certification

Yes, I have a current ESL certification

No, I do not have a current ESL certification

Name on TEA Certificate

TEA ID

Are you willing to host an early field student if not assigned a clinical teacher?

Yes

No

Provide 3 words to describe your teaching style and elaborate/explain

Share any additional information as necessary

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