Personal InformationThis field is hidden when viewing the formDate Submitted Month Day Year Name(Required) First Last Email(Required) Early Care and Education Center(Required)Preferred Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent and SignatureScope of Services The Mentor Teacher agrees to provide mentorship and supervision to apprentices participating in the Early Childhood Registered Teacher Apprentice Program (ECE RTAP). The responsibilities of the Mentor Teacher may include, but are not limited to: Supervision and Competency Development Serving as the primary supervisor for assigned apprentices in a one-on-one capacity, overseeing all on-the-job learning activities. Assisting apprentices in developing program competencies through modeling skills, providing coaching, and offering feedback. Progress Monitoring and Evaluation Conducting monthly one-on-one meetings with apprentices to review and document progress on program competencies. Completing quarterly evaluations of program competencies. Signing off on apprentices’ monthly timesheets to confirm hours worked and program progress. Program Participation and Documentation Attending district orientation meetings and signing the Department of Labor Apprenticeship Agreement Form 671. Completing provided asynchronous Ball State University (BSU) Mentor Module courses and, as available, attending monthly BSU Community of Practice meetings. Uploading all required documentation promptly into the assigned mentor folder. Support and Remediation If an apprentice is not meeting program expectations, collaborating with the Related Technical Instruction (RTI) instructor to develop and implement a performance learning plan. Compensation The Mentor Teacher will receive a stipend of $1172 per school year paid $586 in January and June of the calendar year, which will be paid directly to the individual and not their employer. This stipend is contingent upon the successful performance of the roles and responsibilities outlined above, some of which may require work outside the standard contract day. Terms and Conditions Independent Contractor The Mentor Teacher is engaged as an independent contractor and not as an employee of CIESC. This Agreement does not establish any employer-employee relationship between the parties. Duration of Agreement This Agreement is effective from date signed and will remain in effect until notified of withdrawal from the program unless terminated earlier by either party with written notice. Confidentiality The Mentor Teacher agrees to maintain confidentiality of any proprietary or sensitive information obtained during the performance of this Agreement. Termination Either party may terminate this Agreement with a written 30-day notice. Any stipend payments will be prorated based on work completed up to the termination date. Governing Law This Agreement shall be governed by the laws of the State of Indiana.Consent(Required) I have read and agree to all the above.1099 Consent(Required) I understand I will receive a 1099 tax form for this payment and will be responsible for reporting this income on my annual IRS tax return.Signature(Required)Please use your touchscreen or mouse to draw your signature below.
