College of Education
Office of Field Experiences
MAT Field Experience Assignment Form
District/School mentor must :
(1) hold a Georgia certificate in the same content field as the candidate or in Educational
Leadership,
(2) support the growth and development of the candidate
(3) submit the UWG MAT candidate’s non-renewable certificate (attached).
Responsibilities of a district/school mentor include (Please note this is not a complete list):
• Offer feedback on key assessments
• Provide direction and coaching to the candidate
• Communicate with UWG professors/instructors as needed
• Enter all necessary information, documents, assessments, etc. in Tk20 (the data
repository used and provided by the College of Education).
Candidate’s First Name and Last Name
Mentor Information:
Name:
Mentor’s First Name and Last Name.
Position:
Mentor’s Position.
School Name
and Address:
School Name.
School Address.
School Phone Number:
School Phone Number.
Email Address:
District email address.
GA Certificate Number:
GA PSC Certification Number.
My signature indicates the following:
☐ the UWG candidate is teaching ½ day (three out of six periods) per day in his/her content area
(math, English, history, special ed: gen curriculum, or special ed: adapted, etc.) during the current
academic year (ex. 2020-2021, 2021-2022).
☐ the non-renewable certificate is attached.
Signatures:
Candidate:
Date:
Mentor:
Date:
Return to Helen Chambers, Office of Field Experiences
Email: hchamber@westga.edu
