KCCTE Mentee Application 2023-24

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

2023-2024 Mentee Application

Thank you for your interest in the KCCTE Mentoring Program! We look forward to working with new CTE teachers as they transition into their new teaching roles. In this program, mentees will benefit from having a network of new and experienced CTE teachers to help them navigate through the first two years of teaching CTE courses.

As a result of feedback received from previous mentors and mentees, we have articulated some detailed responsibilities to become a member of the KCCTE Mentoring Program. Please review the information here: Mentee Responsibilities. Please notate the agreement below and then complete this form. Information submitted will assist us as we pair the new CTE teacher with an experienced mentor.

In order to sustain a quality two-year program that prepares individuals for teaching careers, there is a one-time, upfront charge of $2000 for each mentee. If the participant is teaching in an approved Perkins-eligible program, KSDE or KBOR may cover $1000 of the cost. The local district will be responsible for the balance of the payment. Information regarding payment will be sent to the principal/administrator who is designated in the form.

If you have any questions about the mentee responsibilities or the program, please contact mentoring@pittstate.edu

Are you applying as a new CTE teacher?

Yes, I am a new CTE teacher. No, I am completing the application for a new CTE teacher.

Your name and role*

Your email address*

After reading the 2023-24 Mentee Responsibilities, would you like to participate in KCCTE Mentoring?*

Yes No

After reading the 2023-24 Mentee Responsibilities, would you like the new CTE teacher to participate in KCCTE Mentoring Program?*

Yes No

Name of the new CTE teacher*

First Name

Last Name

Name of Person Completing Application (if different than CTE teacher)

First Name

Last Name

Assigned Mentor (completed by admin)

KCCTE Pathway

Thank you for considering the KCCTE Mentoring Program! We are sorry you were not able to agree to the Mentee Requirements as defined. Please remember KCCTE has other options to support CTE teachers. Please visit our website to learn more about workshops, the resource library, and other ways we may be of assistance.

https://kccte.pittstate.edu/

New CTE Teacher Contact Information

Personal Address*

Address Line 1

City

State

ZIP Code

School Email*

School Phone

Personal Email*

Alternate Phone

How do you prefer to be contacted?*

School/Organization Email Personal Email School/Organization Phone Alternate Phone Number

School Information

School Name*

Administrator's Name*

Administrator's E-Mail Address*

School Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County*

Principal/Administrator Approval

COST

To build a quality program, the KCCTE Mentoring Program there is a cost of $2,000 for each mentee. This charge is for the first year of the program, with the second year provided at no charge. For approved entities, KSDE or KBOR will cover $1,000 of the cost with Perkins funds if the participant is teaching in a currently approved Perkins-eligible program. The local district will be responsible for the balance of the payment.

Please enter the name and contact information of the person who should be contacted regarding the payment.

Institution Type

Middle School High School Post-Secondary

Other:

Principal/Administrator Name*

Principal/Administrator Email*

Principal/Administrator Phone*

Confidentiality Agreement

KCCTE Mentoring Confidentiality Statement

For a mentoring relationship to develop, both the mentor and mentee must feel that discussions of private issues or problems are being handled with discretion. The purpose of this agreement is to protect both the mentor and mentee from a breach of confidentiality during the mentoring process.

I agree to keep confidential the specifics of my discussions with my mentor/mentee unless given permission to share this information with others. I am also encouraged to discuss any concerns I have about my mentoring experience with the KCCTE Mentoring Administrator or Program Area Consultant. The KCCTE Mentoring Program Consultant will maintain confidentiality unless a breach of confidentiality is necessary to maintain someone’s personal safety.

I agree to uphold the KCCTE Mentoring Confidentiality Statement.*

Yes No

New CTE Teacher Contact Information

School Information

CTE New Teacher Information

Teaching Information

Principal/Administrator Approval

Confidentiality Agreement