NHC Chicago 2020 Host Site Intent to Apply

Thank you for your interest in hosting National Health Corps (NHC) Chicago AmeriCorps members. Please complete the following short survey to inform us of your intent to apply.

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* 1. Organization Name

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* 2. Primary Contact

Name

Title

Email Address

Phone Number

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* 3. How many NHC Chicago AmeriCorps members do you intend to apply for?

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* 4. Does your organization have experience hosting AmeriCorps members?

Yes

No

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* 5. Provide a brief description of the role you envision for the NHC Chicago AmeriCorps member.

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* 6. Would you like to receive technical assistance during the application process? (Technical assistance may include: calls to review the RFA, the application, and/or the proposed position description).

If yes, we will reach out to the contact person listed above.

Yes

No

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* 7. Please indicate if you have any other questions or concerns in the space below: