Application

 

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

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 mandatory.  

**We are no longer accepting new mentor applications for the 2016-2017 school year. If you would like to mentor in the 2017-2018 school year, please complete the appropriate application below. We will be conducting interviews and training starting in June 2017. In the meantime, consider joining our Events or Behind the Scenes Support Teams. Learn more >

Basic Information
* First Name
* Last Name
Email Address
Password
Confirm Password
Contact Information
Home Address 1
Home Address 2
Home City
Home State
Home Province, State, or Subnational Division
Home Zip Code
Home Country
Home Phone
Mobile Phone
Work phone
Preferred Method of Communication
Home PhoneCell Phone
Work PhoneEmail
Basic
* Date of Birth
Photo
No file is currently uploaded.
Upload File
Marital Status
Spouse First Name
Spouse Last Name
Military Service
Owns a Firearm
Tobacco, Alcohol, and Drug Use Histroy
Motivational Factors Other
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 Country
Drivers License Number
Interests
Skills/Interests
Mentor Preferences for Match
Age Range
Education
School Name
Education Level
Other
Year Degree Attained
Referral
Target Audience
Program Questions
* 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?