Ancell School Alumni Mentor Program

Student Registration

To register for the Ancell Mentor Program, please fill in the form below.

You must complete all fields before we can process your registration.

Biographical Information

First Name:

Last Name:

Student ID:

Male or Female:

Preferred Address:




Preferred Phone:

please use this format xxx-xxx-xxxx

Email Address:

Expected Graduation Date:

please use this format  xxxx

Major and Minor:

What do you hope to gain from this Mentoring experience?


Student Agreement:

By submitting this application you acknowledge and accept the following:

  1. You have read and agreed to your role and responsibility as a Mentee.
  2. Your behavior will be ethical, professional and responsible at all times.  Specific details discussed will be kept confidential. 
  3. WCSU takes no responsibility for the behavior of participants, nor for any advice or information exchanged between you and your Mentor.
  4. You will be given the name, phone number, email address and employment details for your Mentor and asked to hold all information about their mentor in strictest confidence.
  5. If an opportunity for work experience for your Mentor arises, you must notify the Mentoring Coordinator.

I agree to the release of the information in my application as stated.  I also agree that, if matched, I will contact and/or meet with my Mentor a minimum of twice each semester.  At the end of each semester, I will inform the Mentor Program office as to whether this requirement has been met.  I will do this via email at  I will keep the Mentor Program Coordinator updated with my current contact information (address, email, and telephone).


Thank you!  We look forward to working with you this year!

If you have any questions about the Ancell Mentor Program, please contact Elise Silkowski.

Please mark your calendars for Tuesday, September 23rd at 6 pm for our kick off event in the Westside Classroom Building, Rm. 218.

via phone:  (203) 837-8567 or email: