Apply for the Mentoring Program as a Mentor online with the form below. It will be submitted to the Membership Committee. You will be contacted by a member of the Mentoring Program Committee. Otherwise, you may print out the application in .pdf format and can be printed using Acrobat Reader.

These forms are in .pdf format and can be printed using Acrobat Reader.

Mentor App

Contact Information

Background Information

Have you ever been convicted of a crime? *
I teach (or have taught) in: Please check any that apply and write how many years.

Mentoring Interests

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

Mentee Agreement

only for discussion of any pedagogical issues outside of the teaching observation time, either in person, by phone or per email in accordance with the Billing Agreement signed by both parties.
I understand and agree that neither New England Piano Teachers Association (“NEPTA”) nor any Mentee 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 participating in the Mentorship Program. I hereby waive, forfeit, and forever release NEPTA and its Mentees, their successors and/or assigns from any liability, whether personal or professional.

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

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


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

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