Consultation Form for Multi-State AmeriCorps Programs Survey

This consultation form begins the dialogue between the Governor's Office on Service and Volunteerism (GOSV), the State Service Commission for Maryland, and organizations applying for AmeriCorps grants to operate multi-state programs that include Maryland. The GOSV welcomes this partnership and meaningful collaboration.

Once this form is submitted, a GOSV staff member will review and contact you if there are any questions or additional information requested. Please be sure to take a look at the GOSV's website for news on grant opportunities, volunteer recognition, and more.

Thank you for the work you do to improve the lives of Maryland citizens.

Question Title

* 1. Please fill in the requested information about your program in Maryland.

Maryland/Local Contact Name: *

Local Organization Name: *

Address: *

Address 2:

City/Town: *

State:

ZIP/Postal Code: *

Email Address: *

Phone Number: *

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* 2. Please fill in the requested information, if different than above.

Contact Name from Headquarters:

Name of Parent Organization:

Address of Headquarters:

Address 2:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

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* 3. How many years has your program operated in Maryland?

Less than 1 year

1 - 3 years

4 - 6 years

7 - 10 years

10+ years

Other (please specify)

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* 4. How many AmeriCorps members serve per year, in Maryland, through your program (currently and/or as proposed in your AmeriCorps grant application)?

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* 5. Where in the state does your program operate? Choose as many regions as apply.

Central Maryland (Harford, Cecil, Carroll, Howard, or Anne Arundel)

Eastern Shore (any of the 8 counties)

Western Maryland (Frederick, Allegany, Washington or Garrett)

Southern Maryland (St. Mary's, Calvert, or Charles)

Baltimore Metro (Baltimore City or County)

DC Metro (Prince George's or Montgomery)

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* 6. Please describe the services of the AmeriCorps members in your program in 2 - 3 sentences (including site locations, service activities, and expected results).

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* 1. Please fill in the requested information about your program in Maryland.

Question Title

* 2. Please fill in the requested information, if different than above.

Question Title

* 3. How many years has your program operated in Maryland?

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* 4. How many AmeriCorps members serve per year, in Maryland, through your program (currently and/or as proposed in your AmeriCorps grant application)?

Question Title

* 5. Where in the state does your program operate? Choose as many regions as apply.

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* 6. Please describe the services of the AmeriCorps members in your program in 2 - 3 sentences (including site locations, service activities, and expected results).

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* 7. Please describe how you currently collaborate with existing Maryland AmeriCorps programs.