VHCB AmeriCorps Host Site Application 23-24
Please complete and submit this application by May 12, 2023.
The 2023-2024 program year begins in September 2023 and end in August 2024.
You may save this form at any time and return to it via the link provided after you click on "Save and Resume" at the bottom of the form. Please Note: Each time the form is updated and saved, a NEW link is provided and the old one expires. If you lose a resume link, please contact Erin at firstname.lastname@example.org for assistance.
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
Contact Person Name
Contact Person Email
Contact Person Phone
AmeriCorps Slot Requests
Please list the NUMBER of each type of AmeriCorps Positions you are interested in hosting at your organization:
Full-Time (11 months/1720 hours)
Half-Time (6 months/915 hours)
Quarter-Time (3 months/455 hours)
List the NUMBER of each type of position you intend to request
FULL-TIME (1720 hours) Positions
Full-Time Position Title
Name of Supervisor
HALF-TIME (915 hours) Positions
Half-Time Position Title
Name of Supervisor
QUARTER-TIME (455 hours) Positions
Quarter-Time Position Title
Name of Supervisor
Provide approximate impact numbers (e.g. #'s of people placed in housing, #'s of units weatherized, # volunteers, etc.) in each focus area.
Please provide the following estimates:
Individuals Receiving Housing Placement or Homelessness Services
Individuals Transitioning into Safe Affordable Housing
Number of All Individuals receiving supportive housing/residential services
Number of Individuals receiving supportive housing/residential services that are 65 or older, or living with a disability
Acres of Parks and Public Lands Cleaned, Improved, Created or otherwise stewarded
Miles of trails or waterways receiving stewardship efforts
Educated/Trained and surveyed for change in behavior in Energy Efficient, Environmentally-Conscious, or Outdoor Recreation Practices.
These numbers are estimates only; successful host sites applicants are not held to these standards.
Briefly describe any activity the Member will engage in to improve the lives of BIPOC Vermonters, or otherwise create more equitable access to your organization's services.
If the member(s) will be engaged in any COVID relief efforts, please describe briefly:
Which data collection and documentation tools will be used to help members report the impacts of their service activities? Examples data logs, volunteer sign-in sheets, client tracking systems, etc.
Briefly describe your organization's need for AmeriCorps members. Please provide any statistics, data, or other compelling information that demonstrates the need for the proposed position(s).
Capacity to Support AmeriCorps Member(s) and Comply with Program Requirements
What training will the member receive at the Host Site Organization to prepare for the service position? Is the Host Site Organization able to provide additional training and networking opportunities throughout the term of service?
Please list/describe any additional benefits the member will receive from the serving with your organization. Examples include: relevant field experience, housing provided or subsidized, additional training, certifications, non-cash goods, networking opportunites, etc.
Please describe if your organization is in-person, remote, or hybrid. Please describe if a member would be serving in-person, remote, or hybrid and what systems are in place to support them during their term.
Please describe how your organization ensures the safety of its staff. If you have a written safety policy/procedures, you may attach that instead.
Please check that your organization agrees to the following as an AmeriCorps host site:
Able to provide cash match on a quarterly basis (See “Slot Information” for amounts)
Host site is able to recruit for the position and select a member by program deadline.
Able to provide appropriate office space and the equipment and supplies necessary and to provide a safe, healthy service environment.
Able to assist member with data collection and documentation of service activities, including the following: • Environmental Ed: administer simple surveys regarding behavior changes • Residential Services: administer surveys regarding quality of life
Supervisor will meet with the member at least once per week, and has demonstrated skills to adequately support, guide, give feedback, and provide proactive communication with the member.
Host Site is able to provide training to enhance the member's ability to perform his/her responsibilities and support his/her professional development.
Host Site agrees, to the best of their ability, to support the member to successfully complete the service term and to not engage in any activity that would deter the member’s successful completion.
Member position does not displace or duplicate any employed or volunteer positions within the organization.
Member position is direct-service based and is not comprised of capacity building activities such as marketing, systems development, fundraising, or other administrative tasks not directly related to the member’s direct-service activities.
Member position does not include activities of a political or religious nature.
Host Sites will not employ AmeriCorps Members until after they’ve completed their service requirements.
Host Site is able and agrees to communicate all issues of concern and importance to VHCB AmeriCorps staff in a timely manner.
Member position provides activities that are meaningful, challenging, and of appropriate volume, and will allow member to complete AmeriCorps Hours requirements.
Please provide any other information you would like us to know not captured elsewhere in this application.
With this Application, you must also submit the following:
1. Position Description: submitted as a Word Doc, using the 2023-2024 Position Description Template
2. Financial Risk Assessment
3. Supervisor Assessment (only necessary for new supervisors)
The attachments may be submitted here, or emailed to Erin Riley at email@example.com
Position Description (PLEASE use the 2023-2024 Position Description Template)
Financial Risk Assessment
New Supervisor Form (if needed)
Please verify the following:
I understand that VHCB has not yet been awarded grant funds for the 2023-2024 Program Year, may incur unforeseeable reductions to its operating budget, and that these amounts may change prior to the start of the 2023-24 program year.
I understand that the member’s supervisor may be required to attend several meetings/days of training throughout the service year, including one full day of the AmeriCorps Training. I understand that we will be expected to release the member for AmeriCorps-related events for up to 3 days/month on average.
I understand that our organization will be responsible for recruiting the member(s) and its associated costs. Our organization understands that it cannot offer the position to an individual until approval for that selection has been obtained from the VHCB AmeriCorps Director.
I understand that as a service position that it is not possible to ‘dismiss’ a Member after a trial period unless they are clearly performing illegal or unsafe acts, or unless their attitude warrants it, and then if and only if there is clear documentation of these acts and if, and only if, the member has had access to due process. I understand the AmeriCorps position is not intended to, and should not, displace an employed position. I also understand the member will be performing direct services to fill a need that our organization has, and that this need falls within the limits of the mission and objectives of the Vermont Housing and Conservation Board AmeriCorps Program as stated in their AmeriCorps*State Grant Application.
Sign here to verify the information contained within this application is true and accurate: