TEACH@MINES MENTOR TEACHER INTEREST FORM

First Name

Last Name

Email Address

School & District

From which field experience course(s) are you interested in supporting Teach@Mines students? From which field experience course(s) are you interested in supporting Teach@Mines students? K-12 Early Field Experience (25-75 hours) Student Teaching Practicum (~100 hours) Student Teaching Residency (~400 hours)

What grade level(s) do you teach? What grade level(s) do you teach? Elementary School Middle School High School

What subject(s) do you teach? What subject(s) do you teach? Computer Science Math Science STEM Technology Other STEM discipline

What course(s) do you teach?

If you know of any forms or steps needed at the school administration or district level in order to place a student in your classroom, please share them here.

Please share any additional information you would like us to know.