School Reimbursement Form
School or Technology Center
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New Teacher:
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Mentor:
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Instructional Leader:
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Verification of Mentoring Activity
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
Date of Visit
Number of Hours Observing
Synopsis of Visit-Observation Notes/Topics Addressed
We hereby confirm that the documented information is accurate.
On-Site Mentor Signature:
New Teacher Signature:
Instructional Leader Signature:
Submit
Should be Empty: