1. Instructions and Organization Information

Instructions: AmeriCorps strives to create programs that represent and serve the full diversity of the community/our country.  Information below should be self-reported by each stakeholder group/documented by Census data/etc. Please fill out every box that is yellow with information within the last twelve months.

Confidentiality Statement: The information requested does not include any types of personally identifiable information.  Purposes and Uses - The information requested will be collected in the aggregate for each grantee and applicant for funding. It will be used to better understand the demographic characteristics of current grantees and potential grantees to further AmeriCorps’ efforts to take into account the diversity of communities and participants in its grantmaking. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. The information will not otherwise be disclosed to entities outside of AmeriCorps. Effects of Nondisclosure - The information requested is mandatory in order to receive benefits. 

Note: Survey Monkey will not save your answers.  We recommend utilizing Diversity Questionnaire spreadsheet prior to entering in numbers. All questions are required. If no data is available or if there is no representation in a particular group, enter 0.

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* Program Code

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* Name of Organization

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* Employer Identification Number (EIN)

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* Re-enter EIN

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* Application ID

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* Re-enter Application ID

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