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MN Adult Ed
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Contact Information Form – Mentorship Experience
For In-Person and Virtual Meetings
Date
MM slash DD slash YYYY
Name
*
First
Last
Email
*
Please make sure to enter your PREFERRED EMAIL, which will be used on a regular basis for ALL CORRESPONDENCE.
Enter Email
Confirm Email
ABE Program/Consortium/Site
*
Start typing to find program
OTHER - NOT LISTED HERE
MDE
ATLAS
AALC - LeSueur area
Adult Options in Education - Hopkins
AEOA
Alexandria ABE
American Indian OIC/Takoda - Mpls
Brainerd ABE
Burnsville School for Adults
Cass Lake-Bena ABE
Cedar Riverside Adult Ed Collab - Mpls
Central MN ABE - Cambridge-Isanti
Central MN ABE - Freshwater
Central MN ABE - St Cloud Area
CLUES - St Paul
Dakota Prairie/Farmington ABE
DOC: MCF-Faribault
DOC: MCF-Lino Lakes
DOC: MCF-Moose Lake
DOC: MCF-Oak Park Heights
DOC: MCF-Rush City
DOC: MCF-Saint Cloud
DOC: MCF-Shakopee
DOC: MCF-Stillwater
DOC: MCF-Togo
DOC: MCF-Willow River
Duluth ABE
English Learning Center - Mpls
Faribault County ABE - Blue Earth
Federal Bureau of Prisons
GAP School/Change Inc - St Paul
Glacial Lakes ABE
Great Rivers ABE
Hennepin County Corrections
Hiawatha Valley/Red Wing ABE
Hmong Cultural Center
Hubbs Center/St Paul ABE
International Institute - St Paul
Lakes Area ABE
Lakeville ABE
Learning In Style School - Mpls
Literacy Minnesota
Lyndale Education Program/LNA - Mpls
Mankato ABE
Metro EAST ABE - Forest Lake
Metro EAST ABE - Harmony Learning Ctr
Metro EAST ABE - Mounds View
Metro EAST ABE - Roseville
Metro EAST ABE - Stillwater
Metro NORTH ABE - Anoka-Ramsey CC
Metro NORTH ABE - Blaine/main office
Metro NORTH ABE - Brooklyn Center
Metro NORTH ABE - Columbia Heights
Metro NORTH ABE - Elk River
Metro SOUTH ABE
Minneapolis Adult Education
Moorhead ABE
MORE House - St Paul
Neighborhood House - St Paul
NE Regional Corrections Center
NW Indian Community Devel Ctr - Bemidji
NW Service Coop ABE
Osseo ABE
Ramsey County Corrections
RAVE - Rosemount/Apple Valley/Eagan
Red Lake ABE
Robbinsdale Adult Academic Program
Rochester ABE
SCRED/St Croix River Ed District
Somali Success School - Mpls
Southeast ABE - Albert Lea
Southeast ABE - Austin
Southeast ABE - Faribault
Southeast ABE - Owatonna
Southeast ABE - Winona
South Suburban ABE
SouthWest Metro Intermediate District
Summit Academy OIC - Mpls
SW ABE - Fairmont
SW ABE - Marshall
SW ABE - MN West/Jackson
SW ABE - Mountain Lake
SW ABE - MRVED/Granite Falls
SW ABE - Worthington
ThinkSelf/Deaf ABE - St Paul
Tri-County Corrections
Vietnamese Social Services
WEST ABE
White Earth ABE
OTHER: If not listed above, what is your ABE program?
*
Address
*
Please enter the address where we can mail materials to you if needed.
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone
*
Please enter the phone number where you prefer to be reached.
Please note your gender pronouns. We collect this information for hotel arrangements and to be more respectful and gender inclusive in our work.
she/her
he/him
they/them
prefer not to answer
This field is hidden when viewing the form
For in-person meetings, guest rooms can be provided for those who are traveling at least 100 miles roundtrip. Will you need a hotel room reserved for you?*
*
Guest rooms are for the night before the meeting, unless otherwise requested. Gail Rutan will send you confirmation information about your reservation at a later date.
Yes
No
Which type of CEUs do you need? (check all that apply)
*
NOTE: Administrative CEUs are only for those who hold an Administrative license from PELSB.
Teacher CEUs
Administrative CEUs (ONLY for those with an Administrative license from PELSB)
No CEUs needed
SPECIAL NEEDS / DIETARY RESTRICTIONS
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Dietary restrictions/allergies that we can accommodate for in-person meetings:
If you have other dietary requirements, please feel free to bring your own food; we are limited in the types of diets we can accommodate.
Gluten-free (for those with medical restrictions or allergies only)
Dairy-free (for those with medical restrictions or allergies only)
Vegetarian - no fish
Pescatarian (those who don't eat meat but DO eat fish)
Peanut allergy
Other nut allergy
Multiple restrictions - will receive Garden Vegetable salad with vinaigrette
Other NON-dietary needs (to be accommodated to the best of our ability):
Do you require ASL interpretation?
Yes, I need ASL interpretation arranged for me.
Contact Us
Gail Rutan
Senior Events Manager
[email protected]
