Mentor Teacher Profile

Dear Mentor Teacher:

The Tennessee Department of Teacher Education and Accreditation requires compliance with standards and guidelines regarding well-credentialed PreK-12 teachers for support and observation of candidates during the clinical experiences. To assist us with appropriate documentation, please complete this profile. The expertise and service you provide to the LMU Teacher Education Program is greatly appreciated.

Thank you.

Teacher Candidate Name

First NameLast Name

Program

The candidate assigned to you will be completing which type of clinical experiences or clinical practice?

Mentor

First NameLast Name

License Number

Mentor Email

Mentor Phone Number

Area CodePhone Number

Mentor Ethnicity

Optional

Certification / Endorsement Area(s)

Highest Degree of Cooperating Teacher/Mentor

University of Highest Degree

Current School's Name

Current School's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Current Grade Level

Current Content Teaching Area

Years Teaching at Present School

Grade(s) of Previous Teaching Experience

Total Years Teaching

MentorTeacher Signature: