Thank you for your interest in mentoring at Burton School!

**We are now accepting new mentor applications for the 2018-2019 school year. If you would like to become a mentor, please complete this form. Applications will be processed starting in June 2018.***

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
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 PhoneCell Phone
Work PhoneEmail
* Date of Birth
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Marital Status
Spouse First Name
Spouse Last Name
Demographic Information
* Gender
Primary Language
Secondary Language
Secondary Language Other
Primary Religion
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
1. Before School
2. AM Block
3. Lunch
4. After School
5. PM Block
Drivers License
Drivers License State
Drivers License Number
Drivers License Expiration
School Name
Education Level
Year Degree Attained
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?
* Which statement best describes your reading skills?
* 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).
* 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?
Electronic Signature
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By submitting this application, 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.