DIRECT Form January 7, 2000/in Uncategorized /by Amanda Wilson DIRECT Mentor/Mentee FormWhat do you need?*I NEED a MentorI WANT to be a mentor (You MUST be a Certified Teacher- minimum of 3 years teaching)Name*First & last nameSchool/Career Center*School Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Please provide a number where you can easily be reachedSchool Fax Number*School Email Address*If you haven't received a school email address, please provide a personal email address. What is your Medical Certification?*Do you currently have someone you are working with as a mentee/mentor?YesNoWho are you currently working with as a mentee/mentor?Please give the name of the teacher(s) you are currently working with as a mentee/mentor, along with the name of the school. Please provide details regarding your role as a mentee/mentor.What areas are you/will you be teaching?*Check all that apply. Health Science Sports Medicine EMS Medical Terminology Project Lead The Way- Biomedical Science Comments http://schosa.org/wp-content/uploads/2013/04/hosa-brand-southcarolina-standard.png 0 0 Amanda Wilson http://schosa.org/wp-content/uploads/2013/04/hosa-brand-southcarolina-standard.png Amanda Wilson2000-01-07 21:41:152016-09-27 20:14:21DIRECT Form