College of Education and Human Services Western Illinois University Student Teaching Program

College of Education and Human Services
Western Illinois University
Student Teaching Program
Mentor Teacher
Student teaching is the capstone event for the completion of the undergraduate degree and the certification of the candidate as a
professional educator. In order to be successful, four people have to work cooperatively. They are: the Superintendent/or Designee –
Signature, the University Supervisor, the Mentor Teacher and the Student Teacher (candidate). Each has an important role to play in
teacher preparation. The following contract clarifies the role of the Mentor Teacher.
This Agreement is entered into by ____________________________________________ (Mentor Teacher), with an address of
(address, city, state and zip) and Western Illinois University at Macomb, Illinois. Western Illinois University is hereinafter referred to
as the “University” and the Mentor Teacher shall be referred to as the “Teacher.”
TAXPAYER IDENTIFICATION CERTIFICATION (REQUIRED): Under penalties of perjury, I certify that I am doing
business as a (please check one):
_____ Individual
_____Government Entity
_____ Sole Proprietorship
_____ Tax Exempt Organization
_____Non-For-Profit Corporation
_____ Partnership
(RIC 501 (a) only)
_____Trust or Estate
_____ Medical and Health Care Services Provider Corporation
_____Real Estate Agent
BACKUP WITHHOLDING CERTIFICATION: The Mentor Teacher certifies that they are not subject to backup withholding
because: (a) they are exempt from backup withholding; (b) they have not been notified by the Internal Revenue Service (IRS) that they
are subject to backup withholding as a result of failure to report all interest or dividends; or (c) the IRS has notified them that they are
no longer subject to backup withholding; and (d) they are a “U.S. person” (including a U.S. resident alien).
UNITED STATES RESIDENT CERTIFICATION: The Mentor Teacher certifies that he/she is a (please check one):
_____ United States Citizen
_____ Resident Alien
The Internal Revenue Service (IRS) requires that taxes be withheld on payments made to nonresident aliens for the performance of
personal services at the rate of 30%.
It is hereby agreed that:
The Teacher and University shall:
a. Comply with all policies, principles, and procedures contained in the Western Illinois University Student Teaching
Handbook, including attachments, copies of which have been received and reviewed by the Mentor Teacher.
Have the right and professional obligation to terminate a Student Teacher’s assignment, for cause, at any time, after
conferring with the University Supervisor.
The Teacher shall:
a. Put forth his/her faith and effort as the primary supervisor to ensure that the student teacher receives an outstanding
professional learning experience, consistent with the conceptual framework of the University Teacher Education
Program. Should unusual problems result, either in terms of professional preparation or professional ethical/moral
situations; the University Supervisor shall be notified immediately for consultation and/or additional expertise.
Provide constant, constructive, daily feedback, which will allow the Student Teacher (candidate) to make orderly
growth during the professional student teaching experience.
Accept as a condition of this Agreement, University policy with respect to a Student Teacher’s (candidate’s)
position in the event of a strike or work stoppage in the District. This policy requires that the Student Teacher
(candidate) remain neutral and confer with his/her regional supervisor.
Attend and complete any workshops provided by the University relating to improving the student teaching
Assure that the Student Teacher (candidate) not be utilized in any unusual manner or in any emergency situation.
Further, the candidate will not be utilized to provide physical restraint or for crisis intervention as outlined in the
Western Illinois University Position on Physical Restraint and Crisis Intervention.
Assure that the Student Teacher (candidate) will not serve as a substitute teacher. The Student Teacher (candidate)
will not accept any honorariums or salary for any activities (e.g. coaching, directing, supervising, sponsoring) or
other activities normally carried out by faculty in the school as part of his/her regular or extracurricular duties.
Assure that the Student Teacher (candidate) has suitable space and facilities to perform his/her assigned
Assure that the Student Teacher (candidate) has access to all appropriate student handbooks, teacher handbooks,
curriculum guides, school policies, and district policies.
Provide two required evaluations of the Student Teacher (candidate). Further, she/he will meet with the University
Supervisor and Student Teacher (candidate) if there are any significant concerns about the student’s orderly
program. In any case, the University Supervisor, Mentor Teacher and Student Teacher (candidate) will meet to
discuss the Student Teacher’s (candidate’s) progress prior to the assignment of the final grade by the University
Prepare a final evaluation of the Student Teacher’s (candidate’s) performance, using the form provided by the
University. This evaluation shall be subject to the provision of the Public Law 93-380, the Family Education Rights
and Privacy Act of 1974.
Provide prompt responses to requests for information from the University and/or the University Supervisor for all
relevant information pertaining to the Student Teacher’s (candidate’s) progress and all reporting requirements for
administrative needs e.g. mileage vouchers, honorarium requests or attendance information.
The University shall:
Assure that only those Student Teachers (candidates) properly prepared are permitted to apply for a student teaching
assignment. The University assumes full responsibility for appropriately screening all Student Teacher candidates.
Assign a University Supervisor to provide general supervision and oversight of all Western Illinois University
Student Teachers (candidates). University Supervisor will also consult with, and provide assistance to all Mentor
Teachers and Student Teachers (candidates).
Pay to the Mentor Teacher a prorated honorarium. In addition, the University shall provide three, one-semester
hour Tuition and Fee Waivers for each student teacher supervised. Honorarium payments will be made shortly after
final evaluations of student teaching performances are submitted to the University Supervisor.
This agreement shall remain in force until such time as it may be rescinded by either party or superseded by a new agreement.
IN WITNESS WHEREOF, the Teacher and the University agree to the above.
Coordinator, Center for the Preparation of
Education Professionals
Mentor Teacher – Signature
Mentor Teacher – Print Name