Welcome to PENCIL's Partnership Program

Thank you for your interest in mentoring with PENCIL!

Whether this will be your first year or your tenth year with us, we are thrilled to have you on our team. To get started, please take a moment to complete the registration form. Your responses will help us to learn more about you and how you can share your skills and experiences to support New York City public school students. This form should take about 5 minutes to complete, and then you’ll be that much closer to kicking off your PENCIL Partnership.

Please note that we check all mentors on the New York Registry of Sexual Offenders to ensure the safety of the students. We do not share this information or any of your responses with your employer. If you have any questions, please email Hannah Chan at hchan@pencil.org.

First Name

Last Name

Email Address

Phone Number

Date of Birth (MM/DD/YYYY)

Zip Code (required for SAM check)

Employer

Position

Employer?

Deloitte - Which Cohort Will You Be Supporting?

Richard R. Green High School of Teaching

HSTAT - 9th GradeHSTAT - 12th Grade

DTCC- Which School Will You Be Supporting?

George Westinghouse Career and Technical Education High SchoolHudson High School of Learning Technologies

InfoSys - Which School Will You Be Supporting?

High School of Arts and TechnologyHigh School of Telecommunication Arts and TechnologyThomas A. Edison Career and Technical Education High School

Google - Which School Will You Be Supporting?

Astor Collegiate AcademyBushwick Leaders High School for Academic ExcellenceHigh School for Youth and Community Development at ErasmusKIPP STAR College Prep Charter School

JPMorgan - Which School Will You Be Supporting?

J.H.S. 226 Virgil I. GrissomP.S. 226 Alfred De B. Mason - 317 (Vesce)P.S. 226 Alfred De B. Mason - 319 (Velez)The Brooklyn Academy of Global FinancePace High School

Molina Healthcare- Which School Will You Be Supporting?

International High School at Union SquareInternational High School for Health Sciences

EDUCATIONAL HISTORY

Where did you receive your Bachelor's Degree?	Major?
Where did you receive your Master's Degree?	Major?

Where did you receive your Doctoral Degree?

Major?

Did you attend public school?

Yes - Outside of NYCYes - Within NYCNo

Which NYC public school(s) did you attend?

GETTING TO KNOW YOU

Describe your position so a high school student would understand.

What is one goal you would like to accomplish through the PENCIL partnership program?

What are three things you want students to know about you?

One

Two

Three