VHCB AmeriCorps Member Intent to Commit
2023-2024 Program Year
Social Security Number
(required for AmeriCorps Portal enrollment)
By signing this intent to commit, you:
are entering into a good faith agreement to fulfill an AmeriCorps term in the Vermont Housing & Conservation Board AmeriCorps Program
are certifying that you are not required to be listed on the National Sex Offender Registry and have not been convicted of murder
agree to undergo a National Service Criminal History Check and understand that eligibility to serve in VHCB AmeriCorps is contingent on results of the background check.
Please attach a copy of a photo ID to verify your legal name for the National Service Criminal History Check.
Please attach your completed AHS Abuse Check Release
Form can be accessed at: https://www.vhcb.org/sites/default/files/programs/americorps/AHS%20Abuse%20Check%20Release.pdf
Date and location of scheduled fingerprint collection for Fieldprint Criminal Background Check:
(must be scheduled prior to signing this form)
Include name of Business and Town/State
For criminal background check purposes, please write the state in which you were residing in at the time you submitted your AmeriCorps application: