AACS Continuing Education
Supervising Teacher
(Mentor of Student Teacher or Mentor in Approved Program)
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This form is required to verify that the supervising teacher mentored a student in an approved mentoring program or
supervised a student teacher for a full-time student teaching experience. (Typically, the student teacher receives 9 to 12 college
credits for this course.)
School administrator’s signature is required. In lieu of the school administrator’s signature, the supervising teacher can submit
documentation from the college that assigned the credit to the student teacher.
Retain this form. When you submit certification renewal application, include this form (and college documentation, if
applicable) with your other renewal paperwork.
For certificate renewal, no more than 10 contact hours may be for supervising a student teacher or mentoring in an approved
mentoring program.
Supervising/mentoring is valued at 10 contact hours.
Supervising Teacher Information
Name E-mail
Certification Area
All-Level (Music, Art, PE)
Special Education
Specialist (Bible, CIT, Counseling)
Current Certificate Endorsement(s) (Elementary Ed, Music, Math, etc.)
Information for Student Teacher
Name of Student Teacher ________________________________________________________________________________________
College (That Awarded the Student Teacher Credit for Student Teaching) _________________________________________________
College Address (City, State) ______________________________________________________________________________________
Dates of Student Teaching_________________________________ Credits Awarded _______________________________________
Teachers for Tomorrow Mentoring Program
Verifier’s Information
Name of School Administrator or College Program Director _____________________________________________________________
Signature* ______________________________________________ Date ________________________________________________
* Signature verifies the supervising teacher’s participation.
For Office Use Only
Continuing education credit granted
Continuing education credit denied Explanation of denial:
Number of contact hours allowed for activity: _______
Conditions or limitations:
Signature of AACS official Date of Reply_____________________
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