Applications Forms and Submission

The following instructions guide you through obtaining forms and submitting your certification application for the International Mentor Program Certification. Contact Jennifer Smith with any questions.

General guidelines:
Applications may be sent via email or postal mail.  If mailing your packets remember brevity is appreciated but completeness is a must. PLEASE CONDENSE documentation wherever possible. For example, please do not send materials in large, heavy, 3-ring binders; please do not send videos, audio-tapes, computer disks, etc. If each packet exceeds 1/2 inch in depth, you should see if you can combine, delete, and otherwise abbreviate what you're submitting without omitting information essential to the evaluators.  Documentation is mandatory. It consists of patterns of evidence to support your application, i.e., syllabi, objectives, lesson plans, narrative, examples, agendas, etc.  All sources of training material should be fully documented on the REFERENCE form
All forms below are rtf files which can be viewed in any word processing program. 

Submission Instructions:
1. Print or email the following documents: (Use the browser back button to return to this page.)

General Information: 

• CRLA IMPC Purpose, Procedures, Guidelines
• IMPC Benefits
• CRLA IMPC Requirements
• Fact Sheet
• Self-Assessment

Application:

• Cover Sheet
• Narrative Sheet
• Application
• Reference Form

Mailing Instructions*:

• two complete copies of the original set - for evaluators 
• Mail a total of  three complete sets to: Jennifer Smith  

*Applications may be mailed up until September 1, 2008.  After that date all applications should be emailed to jlsmith@mail.utexas.edu

Email Instructions:

• Email application, supporting documentation, and reference form to jlsmith@mail.utexas.edu
• Certification Fee of $75 with a check payable to “CRLA/Mentor Program Certification”.
    Mail to:               DuganData
                                P.O. Box 15685
                                Lenexa, KS  66285

Certification Renewal
This form can be completed online and then printed.  This form must be included with the rest of your documentation.  Gray areas on the forms need to be completed and the sections can be easily maneuvered by hitting your Tab key after completing a section. If a section is not large enough for your text, please either state "see attached" or "continued on attached".  If you do not have Adobe Acrobat, please visit their website for a free download of Acrobat.  Their site is www.acrobat.com.  
Please complete and print the following document and mail to Jennifer Smith.

• Three Year Certification Renewal*
  
  

We encourage your comments, email the webmaster, Corrine Johnson.
Last updated July 28, 2008.