Office of Teaching and Leading
Division of Educator Licensure
Form AME022020
ADMINISTRATOR MENTORSHIP / EVALUATION FORM
Required for applicants in the MS Alternate Path to Quality School Leadership Program
To be completed by the administrator applicant:
Name_______________________________________________________________
Last First Middle/Maiden
Educator ID #______________ Administrative Position_________________________
School District ________________________________ School Term _____________
Superintendent _______________________________________________________
Applicant’s Signature ________________________________________________________
Note: A copy of this form should be placed in the applicant’s personnel folder.
To be completed by administrative mentor:
I have served as a mentor for the administrator applicant named above during the current
school term.
Mentor’s Signature :____________________________________________________
Print Name: ___________________________ Date:_______________________
To be completed by principal where applicant serves in an administrative position:
I have provided a mentorship program for the administrator applicant named above. The
evaluation
of the applicant’s performance is satisfactory unsatisfactory (check one)
Principal’s Signature: ___________________________________________________
Print Name: __________________________ Date:______________________
Note: The principal shall conduct one or more evaluations of the applicant’s performance, using the same
evaluation tools applied to the evaluation of all administrators. The principal shall then indicate if the
applicant’s performance is satisfactory or unsatisfactory.
