Benjamin Cardozo High School Mentoring Center
BNCHS
The New York City Department of Education
Benjamin N. Cardozo High School
Gerald Martori, Principal
57-00 223rd Street, Bayside, N.Y. 11364 Phone (718) 279-6500 Fax (631-7880
MENTOR APPLICATION 2012
It is important that all questions are answered completely.
NOTE: ALL INFORMATION SUBMITTED BY YOU IS KEPT STRICTLY CONFIDENTIAL
Please e-mail to: (gmartor@schools.)
The Cardozo mentor program is being established as a means of providing matriculated Cardozo students with opportunities to leverage the knowledge, experience, and life lessons of Cardozo Alumni. Through the pairing of individual students and mentors the goal of the program is to provide today’s students with insight into the importance of education in today's dynamic economy. The program will focus on bridging the gap between class room instruction and real world application, thereby leaving Cardozo students better prepared to meet the world awaiting them at graduation. Additionally, the program will provide Alumni with the opportunity to contribute to the continued success of Cardozo, its students, and the community at large.
The Mentor program will be officially launched on the 28 of February and will culminate in early June. Over the course of the Winter/Spring semester mentors and mentees are expected to communicate for at least 30 min on a weekly basis, which will be supplemented by periodic events to be held at Cardozo. All applicants are required to fill in the attached form, which should be returned by email no later than January 30th. Any questions regarding the application process can be directed to Principal Gerald Martori at gmartor@schools..
We greatly look forward to your participation and to this opportunity to further strengthen the Cardozo experience.
Sincerely,
Gerald Martori
PERSONAL INFORMATION
Name (Last, First)________________________________________________________________________
Date of Birth: _________________ Gender: __________
Home Phone #: (______)___________-______________ Cell Phone #: (______)___________-_______________
Address: ________________________________________ Apt. #: ___________Borough: ____________________
City: ____________________________________ State: ____________ Zip Code: __________________________
Race: _________________ Marital Status: ______________________ Religion: __________________________
EMPLOYMENT
Name of Employer:____________________________________________________________________________
Business Address: ______________________________________________________Zip Code_______________
Phone #: (_______) _________-____________ Ext._______________ Do you have voicemail? (Yes (No
Business Email: _______________________________________________________________________________
Title:_________________________________________ Department_____________________________________
Supervisor Name: __________________________Supervisor Email Address:______________________________
Please indicate time of day which is most convenient for an interview: ( AM ( PM
Does your personal or job schedule require you to travel out of NYC? ( Yes ( No
If yes, how often do you travel? ___________________________________________________________________
For what length of time? ______________________________________________________________________
ATTENTION! A volunteer will automatically be disqualified if their criminal history reveals a felony conviction at any time for any of the following:
• A sex offense
• A crime against a child
• A felony conviction involving violence
• A felony conviction within the past five years for a controlled substance
A felony conviction is defined as one of several grave crimes such as murder, rape, or burglary, punishable by a more stringent sentence than that given for a misdemeanor.
EDUCATION
Please provide information on your educational background below:
|Level |High School |College |Graduate/Professional |
|Degree Awarded |(Yes (No |(Yes (No |(Yes (No |
|Degree Type | | | |
|(GED, BA, MS, etc) | | | |
|Years Attended |_______ - ________ |_______ - ________ |_______ - ________ |
|Name of School | | | |
|City, State | | | |
AFFILIATIONS/BACKGROUND
Please list any civic groups, clubs, associations, religious activities or organizations of which you are a member: __________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please list any experience you have had with children:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Have you ever participated in any other Mentoring Programs? (Yes (No
If yes, where and when?
____________________________________________________________________________________________________________________________________________________________________________________________
Briefly describe whom you consider a role model and why: ________________________________________________________________________________________________________________________________________________________________________________________________
REFERENCES
Please list the names and addresses of three people who can serve as character references.
• References can be either personal or professional. YOU MAY NOT USE RELATIVES OR SIGNIFICANT OTHERS.
1. Name: ___________________________________ Relationship:
Name of company:______________________________________________________
Email Address: ___________________________________________
Phone: (______) ___________-______________________
2. Name: ___________________________________ Relationship: ________________
Name of company:______________________________________________________
Email Address: ___________________________________________
Phone: (______) ___________-______________________
3. Name: ___________________________________ Relationship: ________________
Name of company:______________________________________________________
Email Address: ___________________________________________
Phone: (______) ___________-______________________
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