2017-2018 AmeriCorps Host Site Application

Host Alliance VISTA and Promise Fellow Members

Overview for Host Sites

Thank you for your interest in hosting AmeriCorps VISTAs and/or AmeriCorps Promise Fellows in 2017-2018 through Minnesota Alliance With Youth! This application will allow you to apply for AmeriCorps VISTAs, Promise Fellows, or both. Host sites may request multiple AmeriCorps Members.

We highly encourage you to use the word version of this application to answer the questions first, and then submit your responses using this online form. Please be sure to use the required templates provided for Promise Fellows and VISTA Members position descriptions and interview questions. The word version and templates can be found on our website at: https://mnyouth.net/work/americorps-opportunities/host.

PLEASE SUBMIT BY FEBRUARY 10, 2017.

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* 1. Host Site Name

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* 2. Host Site Address (Mailing/Billing)

Address Line 1

Address Line 2

City, State, Zip

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* 3. Tax Identification Number of Host Site

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* 4. Congressional District

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* 5. What percentage of the youth served by your school/organization are eligible for free or reduced lunch?

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* 6. Is your organization currently hosting AmeriCorps Promise Fellows?

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* 7. Is your organization currently hosting Alliance VISTA Members?

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* 8. Does your organization currently host other AmeriCorps Members? If yes, please share how many you host and their roles in your organization.

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* 9. Host Site Lead Contact Information

Name

Title

I certify that I am authorized by my organization to apply for AmeriCorps Member/s and my organization understands that by signing this application our site is responsible for the total payment owed to the Alliance based on number of Member slot/s AWARDED. If awarded AmeriCorps Member slot/s we agree to complete a Host Site Agreement and pay a Cash Match of $7,200 per Member slot by July 15, 2017.

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* 10. Acceptance of Electronic Signature of Lead Contact Agreeing to the Above Certification Terms

Yes

14% of survey complete.