I. Personal Information

II. License

Do you hold a current Wisconsin Teacher license? Yes No

If yes, please enter your 6-digit DPI file number:
If you do not know your file number, please click this image to open the DPI website and search by name for your file.

III. Experience (both with MMSD and other school districts)

3. Content Area Experience

Please check all areas in which you have teaching or professional support experience.

Content Grades PK-2 Grades 3-5 Grades 6-8 Grades 9-12 English Math Science Social Studies

Specials Art Family & Consumer Education Foreign Language Instrumental Music Physical Education Technology Education Vocal Music

Other Bilingual Cross Categorical ESL Hearing Impaired Instructional Resource Teacher Learning Coordinator Literacy Coach LMC Nurse Program Support Teacher Psychologist Reading Recovery Social Worker Speech & Language Clinician Title I Visually Impaired

IV. Preferences

1. Location Preference(s)

Please check all location preferences.

East Side
North Side
South Side
West Side

2. Content Area Preference(s)

Please rank numerically, according to preference, any of the content areas in which you are interested in mentoring (1 = 1st choice, 2 = 2nd choice, etc.). If you are not interested in an area, please leave the box blank.

Content Grades PK-2 Grades 3-5 Grades 6-8 Grades 9-12 English Math Science Social Studies

Specials Art Family & Consumer Education Foreign Language Instrumental Music Physical Education Technology Education Vocal Music

Other Bilingual Cross Categorical ESL Hearing Impaired Instructional Resource Teacher Learning Coordinator Literacy Coach LMC Nurse Program Support Teacher Psychologist Reading Recovery Social Worker Speech & Language Clinician Title I Visually Impaired

V. Statement of Intent

Please share with us why you are applying for a position as a Mentor (limit three sentences).

I certify that the answers given by me to the foregoing questions and/or statements are complete true, and correct to the best of my knowledge and without misrepresentation or omissions of any kind. I further understand that the making of any false or misleading statement or omission from or on this Employment Application, or any other document, may be used to deny me employment, or if employed, used for discipline, including termination from employment. I understand that the District shall not be held liable in any respect if my employment is terminated because of false or incomplete statements, answers, or omissions made by me on this Employment Application or any other document. I authorize the Madison Metropolitan School District to make any investigation of my employment history and any other information related to my suitability for employment and authorize any employment references to disclose to Madison Metropolitan School District any such information that they may have regarding me. In consideration of the School District's review of this application, I hereby release the District, its Board, and its agents, as well as all providers of information, from any liability and for any damage which may result from the furnishing and receiving of this information. A copy of this authorization and release is as valid as the original and should be recognized as such.