Tech Mentor Registration Form

Details

The Technology Leader Mentor Program supports new K-12 technology leaders. It provides personalized mentoring, strategic guidance, and practical leadership support. The program helps leaders build confidence and navigate complex district technology responsibilities.

Includes:

15 hours of one-on-one mentoring with an experienced K-12 technology leader.
Kick-off webinar to start the mentoring journey and set expectations.
Quarterly topic-specific webinars for ongoing professional learning and targeted support.
Free registration to SecurED Schools, fully covered for mentees.
50% off registration to IETC (plus access to the in-person meetup).

Visit webpage for more information.

Contact Details

First Name

Last Name

Phone Number

To change your organization, please visit the LTC Account Portal at ltcillinois.org/account.

Job Title

IEIN Number

Organization

To change your organization, please visit the LTC Account Portal at ltcillinois.org/account.

What is your professional experience?

I am a new Technology Leader (1-2 Years)I am established Technology Leader (3+ Years)

Would you like to be contacted about additional mentorship hours?

YesNo

What are you hoping to gain from mentorship?

Scholarships

A limited number of full scholarships are available for Illinois public school employees through the LTC. Each scholarship covers the full $1,500 program fee (15 hours of structured mentorship and support).

I am eligible, and would like to request sponsorshipI am not eligible, and would like to pay for the program

Billing

Fee

Billing

Please provide your home address.

Please provide your district billing address.

Billing Contact First Name

Billing Contact Last Name

Billing Contact Email

Billing Contact Title

Address

City

State

Zip

Cardholder Full Name (First and Last)

Cardholder Email Address

Credit Card Number

Expiration Date Month

Expiration Date Year

CVV

Additional Details

Cancelation/Refund Policy. I acknowledge that all cancelation requests must be made in writing and sent to support@ltcillinois.org. A 100% refund will be granted when the cancellation request is received at least 24 hours before the service starts. Participants who pay with credit cards will be refunded the full amount minus a 3% processing fee. No refund will be granted if the request is received less than 24 hours in advance.

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LTC Event Website Confirmation Page

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