A-State Online Mentor Form

    Please complete the following form certifying your credentials to serve as a mentor to assist the prospective applicant who selected you as the mentor for their chosen field of study. If you meet the minimum qualifications required to serve in this role, you will be required to assist with the following:

    For Educational Leadership Programs (All Programs Except Ed.S. and MSE Reading)
    • Complete the Mentor Calibration training on the professional disposition assessment. This will take approximately 15 minutes to complete and you will upload your certificate of completion here with your mentor signature form.
    • Complete two professional disposition assessments on the mentee. One assessment after the student has completed 12-15 hours and another while the student is in the Supervised Internship course. You will be given access to the dispositions once you have submitted this form and the university has entered your name into the program.
    • Assist candidate as-needed to complete site based activities (i.e. facilitating access to school sites, archives and personnel as needed).
    • Facilitate communication with student and university supervisor for capstone objectives.
    • Evaluate candidate's internship experience and program portfolio upon capstone completion.
    • Maintain communication with university personnel and candidate as-needed. 
    For Ed.S. and MSE Reading Programs
    • Complete the Mentor Calibration training on the professional disposition assessment. This will take approximately 15 minutes to complete and you will upload your certificate of completion here with your mentor signature form.
    • Assist candidate as-needed to complete site-based activities (i.e. facilitating access to school sites, data archives, resources, and personnel as needed).
    • Offer additional formative feedback on candidate's key assessments (papers, or shorter assignments) as indicated by course professors.
    • Additionally document this mentorship (along with papers, or shorter assignments) as required by course professors.
    • Engage in communication with University Faculty and candidate as needed.
    • Note: The Mentor is NOT required to grade or formally assess the candidate.
    Student Information (This information is included in the e-mail you received and helps expedite processing)
    Student's Birthdate
    Student's Birthdate
    Mentor Information
    Years of Experience
    Please complete the following questions where applicable.
    Mentor's Certifications
    Mentor Training Materials
    Please visit the following links to review the required training materials. If your mentee is in the Ed.S. or MSE Reading (or Certificate in Dyslexia), please complete only the TESS Training for Mentors/Clinical Supervisors.
    EDLDA/EDA Completion Certificate

    Verification and Signature
    By submitting this form, I am agreeing that I meet all of the qualifications and agree to the responsibilities described by the Mentor Program. I also agree that I have viewed and acknowledged the training materials provided above and have uploaded my certificate of completion. Please type your full name in the box below if you agree to these responsibilities and submit the form.