Contact Information

Name *

Address *

Email *

Phone

Cell Phone

Best way/times to contact you

Background Information

Educational background: *

Have you ever been convicted of a crime? *

No

Yes

If "Yes", please explain

Describe your teaching experience *

I teach (or have taught) in: Please check any that apply and write how many years.

Please specify how many years in each:

Mentoring Interests

Would you like to observe a teacher in a home studio, non-residential studio (church, music store, other) or in a school? *

Which areas of piano teaching do you want to observe? Please check any that apply.

Specific Repertoire

Specific Period (e.g. Contemporary period)

Other

Can you speak any other languages?

What days or evenings are you available and during which hours?

How often would you be available to observe? (For example: every week, once a month)

For how long a period would you be available to observe? (For example: four weeks, three months)

How do you participate in NEPTA? (Do you attend monthly meetings, teachers’ exchanges, present students in recitals or competitions, serve on a committee or on the NEPTA Board?

Mentee Agreement

I understand that there is no charge for the time that I observe my Mentor’s teaching.

I agree to pay my Mentor’s fee as set forth in the Billing Agreement for any discussion time of pedagogical issues outside of the teaching observation time either in person, by phone or per email.

DISCLAIMER AND WAIVER OF LIABILITY
I understand and agree that neither New England Piano Teachers Association (“NEPTA”) nor any Mentor associated with the Mentorship Program of the NEPTA shall be responsible for any bodily injury, property damage, or loss sustained or incurred by me during the time I am on the Mentor’s premises. I hereby waive, forfeit, and forever release NEPTA and its Mentors, their successors and/or assigns from any liability, whether personal or professional.

I agree to share the information on this application with prospective Mentors and the Mentoring Committee.

I certify that the above information is accurate, to the best of my knowledge.

Please type your full name in the box below. By typing your name and submitting this form to the NEPTA Mentoring Program Committee, you are agreeing to the terms as stated above. *

Recommendations

Please provide two references who are willing to be contacted by a NEPTA Mentoring Program Committee member.

Name *

Address *

Phone (evening)

Phone (cell)

Name *

Address *

Phone (evening)

Phone (cell)

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Mentee Application

Contact Information

Background Information

Mentoring Interests

Mentee Agreement

Recommendations