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Apply to the LM Program
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Forms for Students
Forms for Mentors
View Mentor/Student Teacher Handbook
School Library Media Endorsement
and Library Media Minor

 

APPLICATION TO BE A MENTOR FOR THE SCHOOL LIBRARY PRACTICUM

Please note that all field must be filled in prior to clicking on the Submit button or you will receive an error message. Thank you.

Date: mm/dd/yyyy

Contact Information

First Name: Last Name:
School: District:
Mailing Address:    
City: State:
Country: Zip Code:
Telephone Number:    
E-mail Address:    
Preferred Contact Method:    

 

Educational and Certification Information

From what university did you receive your Bachelors Degree?
Undergraduate major field of study:
   
From what university did you receive your Masters Degree?
Area of concentration:
   
From what university did you receive your Teacher's Certification?
Certification number:
   

From what university did you receive your school library certification/endorsement?
Certification number:

 

Additional Information

Is your School Library/Media certification exam only? Yes No
How many years of library experience do you have? Less than three More than three
Are you currently working as a school librarian? Yes No

Short Biography:

Statement of job responsibilities:

School Library Experience:
(List beginning and ending dates and levels - three year minimum)