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1、EarlyEducatorSupport,LicensureandProfessionalDevelopmentOffice,EarlyEducationUnit,Education&QualitySectionApplicationforMentorand/orEvaluatorIaminterestedto(checkallthatapply):MentorEvaluatePersonalInformationFirstNameMiddleInitialLastNameCurrentEarlyC
2、hildhoodEducationassignmentorotherassignment/responsibility:MailingAddressCityZipCodeCountyHomePhoneNumberCellNumberWorkYourE-MailAddress:WorkE-mail:EducationandLicensingInformationBA/BSMA/MSEd.D/Ph.DProgramMajor(s)/Minor:College/University:Pleasecheck
3、thetypeoflicenseyouhold:B-KSP1or2PreschoolAdd-onOther(listtype):NCDPIMentorTeachertraining:NOYESIfyes,when:NCEducatorEvaluationSystemTraining(NCEES),includingMcRELOnline:NOYESIfyes,when:RelevantWorkExperienceYourmaysubmitaresumewiththefollowinginformat
4、ion.JobTitleEmployerEmployer’sAddressDateofEmploymentApplicationCheckList(checkallthatapply)CurrentResume3ReferenceLettersRequestedCompletedResponseQuestionsCopiesofPerformanceEvaluationsAttachedCopyofTeachingLicenseAttachedCopyofEvaluatorTrainingCerti
5、ficateAttachedCopyofMentorTrainingCertificateAttachedMailcompletedapplicationtothefollowingaddress:EarlyEducatorSupport,LicensureandProfessionalDevelopmentOffice,EarlyEducationUnit,Education&QualitySection,DCDEE,NCDHHS2201MailServiceCenterRaleigh,NC276
6、99-2201Signature:_____________________________________________________Date:_______/_______/_______REV8.20.2013EarlyEducatorSupport,LicensureandProfessionalDevelopmentOffice,EarlyEducationUnit,Education&QualitySectionMentorand/orEvaluatorResponseQuestio
7、nsThankyouforyourinterestinbecomingaMentorand/orEvaluatorforinitiallylicensedEarlyChildhoodEducationteachersworkinginnonpublicschools/programsinNorthCarolina.Inthespaceprovided,writearesponsetoeachofthesequestionsrelatedtotherole(s)youareapplyingfor(th
8、erearenorightorwronganswers).Pleaseattachthisformtoyourapplication.1.WhatskillsdoyouthinkaMentorand/orEvaluatorshouldhaveinordertoestablishaproductivehelpingrelationship?2.WhatcommunicationskillsshouldaMentorand/orEvaluatordemonstrate?3
