Mentorship (Teacher Aide) Application for the 2013-2014 School Year The mentorship course is a one credit, full-year course that provides students with an opportunity to work with a teacher at Centennial in a leadership role, where they can mentor fellow students in a specific subject and assist the teacher with general duties.
Please complete the application below and return to the Counseling Office by Tuesday, March 19, 2013. Student’s Name: _________________________________________________________________ Student’s Email Address: __________________________________________________________ Student’s Phone #: _____________________
Orig. Yr of Graduation (Ex: 2014): _______
Numeric Average (as of 12/2012): __________
# of Credits Earned (as of 12/2012): _______
1. What is your motivation for wanting to be a student mentor?
______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ 2. Who is the teacher you would like to assist? Students who work as a mentor with a specific teacher will be responsible for providing one-on-one tutoring, homework assistance, and/or remediation to fellow students in a classroom environment, as well as other duties as assigned by the teacher. Subject: _________________________
Teacher: _________________________________________ Teacher Signature: _________________________________
Please read the statements below. Put a check in each box to indicate your understanding:
□ □ □ □ □
I understand the recommendation to take at least 4 academic classes in my senior year. I understand that, as a mentor, I will be in a leadership position representing Centennial High School, and I am expected to conduct myself in an exemplary manner. I understand that I will receive a grade and credit for this course, based on my performance. I understand that my grade will count toward my overall GPA and class rank. I understand that good attendance and discipline are an important part of being a mentor, as others will be relying on me.
Student’s Signature: _____________________________________
Date: ______________
Parent’s Signature: ______________________________________
Date: ______________
