Rev 4/16/2019

Date: __________________________ Applicant: ___________________________________

Ancillary Mentor Teacher Certification

Certificate requirement:

Requirements Completed:

Yes No

Requirements

___ Hold a valid Louisiana teaching certificate

-OR-

___ Have at least two years successful teaching with effective evaluations via Compass if serving uncertificated in a charter school.

Successfully complete a BESE-approved Mentor Teacher training program (documented with completion certificate from program provider)

Passed appropriate number of assessments on the Louisiana Mentor Teacher assessment series (see assessment chart below)

* Individuals who hold National Board certification are eligible for Mentor Teacher ancillary certification after passing the coaching-related components of the Louisiana Mentor Teacher assessment series.

Certification Area Name of Test

Number of Passed

Assessments required

Mentor Teacher

Louisiana Mentor Teacher Assessment Series—Elementary 6

Louisiana Mentor Teacher Assessment Series—Secondary ELA

4 Louisiana Mentor Teacher Assessment Series—Secondary Math

Louisiana Mentor Teacher Assessment Series—Universal

Renewal Guidelines: Valid 5 years; renewable by successfully meeting the standards of

effectiveness for at least three years during the five-year renewal period in accordance with LAC 28:CXLVII (Bulletin 130) and R.S. 17:3902.

Certification Specialist: ____________________________________ Date: ________________