EmailMe Form - VHCB AmeriCorps Host Site Application 23-24

Applicant Information

Organization Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Contact Person Name *

First Last

Contact Person Email *

Contact Person Phone *

### - ### - ####

Website

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
1
2
3
4
5

HALF-TIME (915 hours) Positions

	Half-Time Position Title	Name of Supervisor
1
2
3
4
5

QUARTER-TIME (455 hours) Positions

	Quarter-Time Position Title	Name of Supervisor
1
2
3
4
5

Focus Areas

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.

Organizational Need

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:

Please provide any other information you would like us to know not captured elsewhere in this application.

Attachments

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 e.riley@vhcb.org

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:

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Name

First Last

Date

MM / DD / YYYY