Mentor Application

Apply for the Mentoring Program as a Mentor online with the form below. It will be submitted to the Membership Committee. You will be contacted by a member of the Mentoring Program Committee. Otherwise, you may print out the application in .pdf format, using Acrobat Reader, and mail it. If you don't have Acrobat Reader, you can download it for free:Click here to download Acrobat Reader

Contact Information
Name:
Address:
Telephone (Day):
(Evening):
Email Address:
Best way, times to contact you:
Background Information
Educational background:
Have you ever been convicted of a crime? No Yes - If "Yes" please explain:
Describe your teaching experience:

I teach (or have taught) in: Please check any that apply and write how many years.

* Home studio years * Conservatory years
* Non-residential studio years * Community Music School years
In students' home years Public School years
* Music Store years * Church years
* University or College years Other years
* Please list the towns where you teach, indicating Home studio, etc.

 

Mentoring Interests

What do you consider your areas of special competence to be? Please check any that apply.

Teaching adults Computer lab
Teaching young children Theory
Group or class teaching Composition
Teaching ensembles Jazz
Specific Repertoire:
Specific Period (i.e. Contemporary period):
Other:
Can you speak any other languages?
What days or evenings are you available and during which hours?
How often would you be available for observation? (For example: every week, once a month)
For how long a period would you be available for observation? (For example: four weeks, three months)
How do you participate in NEPTA? (Do you attend monthly meetings, teachers' exchanges, present students in recitals or competitions, serve on a committee or on the NEPTA Board?
What requests do you have of a Mentee in your studio?
Mentor Agreement

I understand that there is no charge for the time that the Mentee is observing my teaching.

I will bill my Mentee $ /hour only for discussion of any pedagogical issues, either in person, by phone or per email.

DISCLAIMER AND WAIVER OF LIABILITY

I understand and agree that neither New England Piano Teachers Association (“NEPTA”) nor any Mentee associated with the Mentorship Program of the NEPTA shall be responsible for any bodily injury, property damage, or loss sustained or incurred by me during the time I am participating in the Mentorship Program. I hereby waive, forfeit, and forever release NEPTA and its Mentees, their successors and/or assigns from any liability, whether personal or professional.

I agree to share the information on this application with prospective Mentees and the Mentoring Committee.

I certify that the above information is accurate, to the best of my knowledge.

Please type your full name in the box below. By typing your name and submitting this form to the NEPTA Mentoring Program Committee, you are agreeing to the terms as stated above.

Recommendations:
Please provide two references who are willing to be contacted by a NEPTA Mentoring Program Committee member.
Name:
Address:
Telephone: Evenings:
Email:
Name:
Address:
Telephone: Evenings:
Email:
 
Type what you see in the image above.