Qualtrics Survey | Qualtrics Experience Management

2024 Mentee Enrollment Form

MentorMT supports Montana's new or underprepared rural teachers! Complete this application to enroll yourself or recommend someone to be matched with a mentor in their grade level and subject area. Applications are open to all Montana K-12 teachers.

OPI cohort teachers will be notified in November when you have been matched with a mentor for the 2024-2025 school year. Other applicants will be matched as funding and personnel allow. Enrollment does not guarantee immediate matching.

Administrators:

Please confirm your teacher's willingness to participate before submitting their name.
Enroll as many teachers as needed, but complete a new survey form for each teacher.
You may complete applications for anticipated hires - write "TBD" for the teacher's' name and contact information.

LAST name of the teacher to be enrolled

FIRST name of the teacher to be enrolled

EMAIL for the teacher to be enrolled

PHONE NUMBER for the teacher to be enrolled

SCHOOL NAME where this teacher is employed (or write TBD)

CITY/TOWN where this teacher's school is located (or write TBD)

Please select the best description of your situation for 2024-2025.

I am an ADMINISTRATOR enrolling a teacher
I am a TEACHER and I KNOW WHERE I will teach

Administrator's LAST name

Administrator's FIRST name

Administrator's EMAIL address

Administrator's PHONE number

Administrator's role

Principal
Superintendent
Both principal and superintendent
Other

List all grade band(s) and subject areas this teacher is currently licensed to teach, or enter "No license."

What is the employment status of this teacher for 2024-2025? (check all that apply)

Licensed teacher, teaching within their licensure area
Licensed teacher, but teaching outside subject area endorsement
Licensed teacher, but teaching outside grade level endorsement
Non-licensed teacher on emergency authorization
Non-licensed teacher on provisional license
International teacher in a visa program
Other (please explain in the next item)

If you answered "Other" in the previous item or need to clarify a choice, please explain here.

Please give a detailed description of this teacher's class assignment for academic year 2024-2025. Be specific about grade level(s) and subject(s). Here's an example for a teacher placed in secondary mathematics: "Grades 7-8 general math, Algebra 1, AP Statistics"

(OPTIONAL) Additional background information that may help us match this teacher with a mentor.
Be sure to click the "Continue" button below to finalize your survey responses!