District/Charter and Mentor Recommendation for
Alternative Authorization – Teacher to New Endorsement
OPTION III or IV Completers
This form must be completed, signed and included with the application for completers of Option III or IV of the
Alternative Authorization – Teacher to New Endorsement in order to qualify for the Idaho five-year renewable
certificate. The intent of this form is to verify completion of a one-year state-board approved mentor program
and successful evaluations.
Section I – Applicant’s Full Legal Name
Date of
Birth
EDUID (Optional)
Section II – Option Completed
Check the applicable program completed
☐ Option III: Master’s Degree and Mentoring Route
☐ Option IV: Content Assessment and Mentoring Route
Section III – Endorsement/Assignment Verification
List the endorsement title, assignment/area of instruction taught, and content grade level range.
Endorsement Title
Assignment/Area of Instruction and
Content Grade Level
Section IV – Mentor Verification
The mentor assures the candidate demonstrates the competencies below:
☐ The mentor assures the applicant is able to develop and revise a classroom management plan to include
managing classroom procedures for efficient operation of the classroom and responding to student
behavior to maximize instruction.
☐ The mentor assures the applicant is able to develop a variety of instructional strategies to engage
students in learning, meet the needs of diverse learners, and differentiate instruction.
The mentor assures the applicant is able to create, revise, implement, administer, and interpret student
performance data from a variety of assessment types, including but not limited to formative, interim and
summative assessments.
Signature of the Mentor Teacher
Page 1 of 2 Updated August 5, 2020
