Thank you for your interest in mentoring at Southwest Community Campus [SWCC]!

**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 at SWCC happens at the school during the school day [typically over lunch] or after school [4-5pm] 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 Phone Cell Phone
Work Phone Email
* Date of Birth
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Marital Status
Spouse First Name
Spouse Last Name
Military Service
Tobacco, Alcohol, and Drug Use Histroy
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
Document Type 1 Other
Document Type 2 Other
Program Questions
What is your t-shirt size?
* How did you hear about Affinity Mentoring?
* Have you used any other names? [Maiden, Married, Alias, etc.]
Secondary E-mail Address
Do you use a nickname? If so, what is it?
* 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?
* What skills or special interests do you have that you would like to share with the school or program?
* 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.
* 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).
* At which site do you prefer to serve?
* How do you prefer that we communicate with you?
* Please list the first and last name of an emergency contact as well as a phone number for your designated contact.
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.