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1099 Form for Administrative Mentor

Information REQUIRED for SUU Accounting Office ( Please Print )

                          Administrative Mentor

Name
Soc Sec #
Mailing Address
City
State/Zip Code

 

This form must be attached to all requisitions for honorariums, stipends, clinical faculty, referees, and other conctracted services. Otherwise the requisition cannot be processed.

 Administrative Intern :                                                                                                                                

                                                                                                                                         

Dates of Administrative Internship Experience:

Semester:     Fall                               Spring                           Summer                

 

Please return to: 

Southern Utah University
Graduate Studies in Education
Attn: Gina Wood
351 West University Boulevard - CC 111
Cedar City, UT 84720 

Fax: (435) 865-8485

 

 

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Dear Administrative Mentor Principals,

Thank you for accepting the responsibility of mentoring a graduate administrative/supervisory license candidate at your school. Forms relating to the internship and other information are available online at . The following forms are in "pdf format", so please complete them out online and return them to our office by fax (435-865-8046)or mail.

1099 form - A stipend of $100.00 will be sent to the administrative mentor at the end of the internship. If two or more are mentoring the same intern this amount will be divided proportionally. Please complete this form and returned to our office no later than 30 days following the completion of the internship. This form can be submitted electronically through e-mail or printed and mailed to our office.

Mid-term report - Please complete this form when your intern has completed approximately 100 hours.

Administrative Leadership Candidate Final Evaluation Appraisal Form - The final evaluation for administrative interns is located online at the above web address. Please complete, sign on the last sheet of the comment area, and fax to our office. It assesses, in your professional judgment, whether or not the administrative leadership candidate demonstrates an understanding of and the capability to meet the nationally recognized educational leadership standards.  They are not expected to have met them at this point, but rather to demonstrate their ability to do so as an administrator.  Please complete this form towards the end of your intern's experience (this form is in the process of being revised to simplify information).

 The administrative candidate has a Portfolio/Artifacts Component to complete that will require your assistance.  You will also need to sign off their hourly accountability form verifying the hours they have completed:

The 200-hour requirement has been met for Elementary
The 200-hour requirement has been met for Secondary

Please send the completed forms to the above address or fax. If you have any questions, please don't hesitate to call.

Sincerely,

Katy Herbold
Director,
Graduate Studies in Education

 

 

 

 

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