FY 25 Professional Pathways Mentor Application Form

Professional Pathways Application

Please complete this form to apply for mentorship opportunities
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What county do you reside in?
What is your address?
I am interested in applying to be a:
Qualifications for Peer Mentors include
- Being currently licensed and in good standing for 2 years or longer
- Rated a level 3 or higher in Early Achievers
- Currently serve at least one child who is receiving a subsidy
Qualification for Apprentice Lead Mentors
- Currently licensed and in good standing for 2 years or longer
- Rated a level 3 or higher with Early Achievers
- Currently serve at least one child who is receiving a subsidy
- Served as a peer mentor for at least 2 years
- Willing to become a state-approved trainer
- Able to assist the lead mentor in facilitating a cohort of interns weekly throughout the 8-month Imagine U program
Qualifications for Lead Mentors
- Currently licensed and in good standing for 2 years or longer
- Rated a level 3 or higher with Early Achievers
- Currently serve at least one child who is receiving a subsidy
- Served as a peer mentor for at least 2 years and apprentice lead for 1 year
- Currently a state-approved trainer
- Able to lead a cohort of interns weekly throughout the 8-month Imagine U program
I understand and meet the qualifications for the {iAm} role

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Street Name and Number
Unit #
City
State
Zipcode

Rows	No Knowledge	Limited Knowledge	Basic Knowledge	Advanced Knowledge
Using computers, the internet, and online tools
Sending and receiving emails
Managing an online calendar
Using Microsoft Word or other word processing applications
Using Microsoft Excel of other spreadsheet applications
Using Zoom or other virtual meeting software

Professional Pathways Application