Application

 

Thank you for your interest in mentoring at Burton School!

**We are accepting new mentor applications for the 2018-2019 school year. If you would like to become a mentor this fall, please complete this form. ***

Mentoring happens at the school during the school day [between 8:30am-4:30pm] for one hour each week and can include eating lunch, reading together, helping with schoolwork, playing learning games, and spending time on the playground.

Interview, background check, and participation in training are required.  

Basic Information
* First Name
Middle Name
* Last Name
Email Address
Password
Confirm Password
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Zip Code
Home Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home Phone Cell Phone
Work Phone Email
Basic
* Date of Birth
Photo
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Marital Status
Spouse First Name
Spouse Last Name
Demographic Information
* Gender
Primary Language
Other
Secondary Language
Secondary Language Other
Ethnicity
Other
Primary Religion
Other
Availability
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Transportation
Drivers License
Drivers License State
Drivers License Number
Drivers License Expiration
Interests
Skills/Interests
Education
School Name
Education Level
Other
Year Degree Attained
Documents
Document Type 1 Other
Document Type 2 Other
Program Questions
* How did you hear about Affinity Mentoring?
Do you use a nickname? If so, what is it?
* Have you used any other names? [Maiden, Married, Alias, etc.]
Secondary E-mail Address
* We ask that you commit to 1 student, for 1 hour a week, for 1 school year. Do you anticipate that you will miss more than 4 weeks of mentoring throughout the school year?
* What do you expect to give to the child you mentor?
* What do you expect to gain personally?
* Have you ever been convicted of, plead guilty or no contest to a crime other than a minor traffic violation? If yes, please explain.
* At which site do you prefer to serve?
* Reference #1 (A non-relative that you have known for longer than a year. Please include the name, relationship, phone number and e-mail address).
* Reference #2 (A non-relative that you have known for longer than a year. Please include the name, relationship, phone number and e-mail address).
* Which statement best describes your reading skills?
* Please list the first and last name of an emergency contact as well as a phone number for your designated contact.
* How do you prefer that we communicate with you?
What is your t-shirt size?
Electronic Signature
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By submitting this application, I hereby represent and warrant that the information contained in the application is correct and complete to the best of my knowledge. I authorize any references, of any other person or organization, whether or not identified in this application, to give you any information [including opinions] regarding my character and fitness for volunteer service. I consent to a criminal history check [national and/or state level]. My signature on this form authorizes you to make such checks and to disclose the results to both Affinity Mentoring and Grand Rapids Public Schools personnel as part of the mentoring program. I grant Affinity Mentoring permission to share my name, contact information, and status as a mentor as necessary and appropriate for the continuity of the mentoring relationship.