Youth in Action AmeriCorps
Mentor Site Application 2014-2015
Vision
Youth in Action AmeriCorps builds a strong community through
commitment to positive and active citizenship.
Mission
Youth in Action AmeriCorps delivers a quality program that provides
service opportunities to individuals who develop valuable professional
skills and experience while benefiting our community.
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Youth in Action AmeriCorps (YiA)
Current Project Requirements
Program Year 2014-2015
Application Due: 5 p.m. on Friday, June 13, 2014
Awarded Sites Notified By: 5 p.m. on Friday, June 27, 2014
In addition to the application, you must complete the following:
1. Email YiA AmeriCorps a current Copy of Agency Liability Insurance (details below, #8)
2. Attend Site Interest Session (details below, #14)
3. Email a position description for each position that you are applying for using the format on
page 8 of this document to americorps3@gmail.com.
Criteria for being chosen as a YiA AmeriCorps mentor site:
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Returning sites must have been in good standing with the YiA AmeriCorps office in the past
(paid invoices on time, completed all necessary documentation in a timely fashion, and
provided a mentoring experience for AmeriCorps Members).
Goals of the site and of the specific positions are a good fit for the community focus areas
(details below #4).
Site has identified a staff member who has the time, expertise, and training to mentor. Sites
must also identify a back up mentor who can fill in if the primary mentor is away. (Note:
Site must identify one Primary Mentor per every 2 Full Time or 4 Half Time Members).
Site has shown that they have a funding source to pay for the cash match (detail below #9).
Overview of Requirements and Guidelines:
Annual Term
1. The grant year starts on September 1, 2014 and ends on August 31, 2015.
2. For returning sites who have a member who is renewing, those returning members will start
September 3, 2014. New members will be inducted on September 30, 2014 and may start at
their site after induction.
3. We may have slots open for Half Time and Quarter Time positions in spring 2015. Please
express interest in those slots in this application.
Community Need Focus Areas
4. AmeriCorps Members will develop, lead, deliver and evaluate a project that fills a substantiated
community need. The focus areas for projects are: Disaster Services, Economic Opportunity,
Education, Environmental Stewardship, Capacity Building, Encore, Healthy Futures, and
Veterans and Military Families. For new sites, we are most interested in projects that address
Economic Opportunity, Education, or Disaster Services.
Self-Sustaining Projects
5. Projects need to be self-sustaining and continue to meet the community needs on or before
the current funding cycle which ends August 31, 2015.
6. Continuing sites must reapply each year describing how the AmeriCorps member will continue
to serve on current projects, or propose a new project that will also need to be completed on or
before August 31, 2015.
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Member Development
7. The Mentor must provide the Member with opportunities to experience personal, professional
and community growth. This will be achieved through training and guidance provided by the
mentor site and the YiA Professional Development Series and Esprit de Corps events. The
mentor site must allow time for the member to participate in these activities.
Liability Insurance
8. You must submit proof of liability insurance (see details below) with your application.
Commercial General Liability: with minimum limits of $1,000,000 per occurrence, and an unimpaired products
and completed operations aggregate limit and general aggregate minimum limit of $2,000,000. Coverage shall be
at least as broad as the Insurance Service Office, Inc. Form CG25031185, used on an Occurrence basis, and
endorsed to add the State of Arizona, Arizona Board of Regents/Northern Arizona University as an Additional
Insured with reference to this contract. The policy shall include coverage for: Bodily Injury; Broad Form Property
Damage (including completed operations); Personal Injury; Blanket Contractual Liability; Products and Completed
Operations, and this coverage shall extend for one year past acceptance, cancellation or termination of the
services or work defined in this contract; Fire Legal Liability.
Cash Match
9. AmeriCorps funding requires mentor sites to provide a cash match payment payable within
thirty days of member placement and invoicing that does not come from federal funding
sources. AmeriCorps mentor sites are also required to provide in-kind matching documentation
on a quarterly basis while the AmeriCorps member is serving at the site.
10. Cash Match Amounts are the same as the last funding cycle:
Full Time Member = $6,800; Half Time Member = $4,000; Quarter Time Member = $2,600.
Background Check and Accompaniment
11. YiA AmeriCorps is required to screen applicants in accordance with Corporation for National
and Community Service (CNCS) regulations as well as NAU regulations. An applicant will be
ineligible to serve in our program if they: 1) are a registered sex offender or required to register
as a sex offender, 2) have been convicted of a felony, 3) refuse to comply with background
screening. We will screen members for these criteria and notify the site when a member
clears the background screening.
12. Sites should have a policy on criminal history checks for staff and members serving at their
site. Sites must be able to provide YiA AmeriCorps with a list of offenses that would bar a
member from serving in each position that they host. In addition, staff who will be providing
accompaniment to new members who are pending background checks, need to have cleared
the criminal history check at their site.
13. Sites will need to be prepared to provide accompaniment for members who are serving with
access to vulnerable populations before their background checks have cleared.
Site Interest Meetings
14. All sites (returning and new) must attend one information session. Please send at least one
staff member who is listed on this application. The dates and times are listed on the following
page as “Mandatory Meeting for Interested Sites”.
AmeriCorps is a federally funded and YIA’s program is contingent upon grant funding. Everything
in this application is contingent upon funding.
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Date
Event Description
Location
Who Should
Attend?
5/29/14
9 – 10:30 am
6/3/14
2:30-4:00 pm
6/6/14
1-2:30 pm
6/13/14
Mandatory Meeting for Interested
Sites (Option 1 of 3)
Mandatory Meeting for Interested
Sites (Option 2 of 3)
Mandatory Meeting for Interested
Sites (Option 3 of 3)
Site Applications Due
NACET
Site Staff
County Health,
2625 N. King St
Coconino Center
for the Arts
NA
Site Staff
6/27/14
Awarded Sites Notified
NA
7/2/14
9-10:30 am
Site Information Session –
Recruitment
Habitat for
Humanity
6/30-7/11
YiA AmeriCorps Site Visits at New
Sites
Deadline for current members in
good standing to declare intent to
renew & have spot reserved
Recruitment Event
7/16/14
7/22/14
9-11 am
8/22/14
8/28/14
9/3/14
9/5/14
9/10/13
9/11/14
9/16/14
9 am – 1 pm
9/19/14
9/24/14
9/30/14
9 am – 1 pm
9/30/14
10/13/14
10/17/14
10/25/14
Deadline for returning sites to
confirm they are accepting returning
members
NAU Recruitment Event
Site Staff
Any Site Staff Handling
Recruitment
Required for New Sites
Primary Mentor
Required for New Sites
NA
County HR, 420
N. San Francisco
NA
Site Staff MAY attend
to promote positions
NAU
Site Staff MAY attend
to promote positions
Returning Members
Mandatory Orientation: Returning
members only
Recruitment Event
TBD
Deadline for sites to select new
members
National Day of Service event
NA
City Hall
Returning Members
Mandatory Mentor Boot Camp
Coconino Center
for the Arts
TBD
Mentors and Back Up
Mentors
New Members
TBD
New Members
TBD
All Members and
Mentors
Mandatory Orientation: New
Members Part A (Fingerprinting &
Forms) (Option 1 of 2)
Mandatory Orientation: New
Members Part A (Fingerprinting &
Forms) (Option 2 of 2)
Mandatory Orientation: All
members (True Colors and
Induction)
Official Start Date: New members
First Time Sheet due for New
Members
First pay day for New Members
First National Day of Service &
EDC for New Members
TBD
Site Staff MAY attend
to promote positions
NA
NA
NA
All Members, Mentors
also welcome
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Youth in Action AmeriCorps
Mentor Site Application 2014-2015
Form Directions: Click on the gray box to type in your specific information. The gray text box will expand to hold
the text that you provide. There is no limit on the text entered unless otherwise specified in each section.
SITE
Site Name:
Mailing Address:
Physical Address:
Main Phone Line:
STAFF
Site Designated Mentor (who will mentor member)
 Name:
 Phone:
Email:
Site Designated Back Up Mentor (who will mentor
member when mentor is on leave)
 Name:
 Phone:
Email:
Would Back Up Mentor like to receive all of the emails
that mentors receive?
Yes
No
Fax line:
Web Site:
Other Organizational Information:
Director (individual responsible for
program/dept/organization)
 Name:
 Phone:
Email:
Would Director like to receive all of the emails that
mentors receive?
Yes
No
Accountant/Business Manager (individual
responsible for the invoice and in kind reports)
 Name:
 Phone:
Email:
Would Accountant like to receive all of the emails that
mentors receive?
Yes
No
Additional Staff (use this space to add any additional
staff members who are relevant to this application)
CASH MATCH
Source of Funding for Cash Match:
State Funding
Local (City or County) Funding
Private Funding
Other _________________
Reminder: The cash match cannot come from
federal funds.
Cash match will be due thirty days after
invoicing of member placement.
MEMBER REQUEST
Please indicate how many members your site is
requesting:
Full Time (FT) Member
(1700 hours, Cash Match $6,800)
How many FT members?
Half Time (HT) Member
(900 hours, Cash Match $4,000)
How many HT members?
Quarter Time Member
(450 hours, Cash Match $2,600)
How many QT members?
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Directions: Click on a gray text box to type in your information. The gray box will expand to hold the text that you
provide.
1. Would any of your staff be interested in a Volunteer Management and Mentoring Training
Series? This would require an additional cost.
2. Priority of this application will go to positions which start in the fall (September 3rd for Returning
Members or September 30th for New Members). We usually are able to open up additional slots in
the winter or late spring. Are you interested in 6 month or 4 month positions that would start in
winter or spring of 2015? (example answer: “YES: Summer, two 450-Hour positions”)
3. Which of these Community Focus Areas will your site address? Please identify all focus areas
that apply in the grey box below.
 Disaster Services
o focus on: increasing the preparedness of individuals, increasing individuals'
readiness to respond, helping individuals recover from disasters, and helping
individuals mitigate disasters
 Economic Opportunity
o focus on: improving access to services and benefits aimed at contributing to
enhanced financial literacy, transitioning economically disadvantaged people into or
remain in safe, healthy, affordable housing, and improving the employability of
economically disadvantaged people leading to increased success in becoming
employed
 Education
o focus on: school readiness for economically disadvantaged young children,
educational and behavioral outcomes of students in low-achieving elementary,
middle, and high schools, and preparation for and prospects of success in postsecondary education institutions for economically disadvantaged students
 Environmental Stewardship
o focus on: decreasing energy and water consumption, improving at-risk ecosystems,
increasing behavioral changes that lead directly to either of the above, increasing
green training opportunities that may lead to either of the outcomes above
 Capacity Building
o focus on: recruiting and/or managing community volunteers, implementing effective
volunteer management practices, completing community assessments that identify
goals and recommendations, and developing new systems and business processes
or enhancing existing systems and business processes
 Encore
o focus on: recruiting and mobilizing volunteers age 55 and over
 Healthy Futures
o focus on: increasing seniors' ability to remain in their own homes with the same or
improved quality of life for as long as possible, increasing physical activity and
improving nutrition in youth with the purpose of reducing childhood obesity, and
improving access to primary and preventative health care for communities
 Veterans and Military Families
o focus on: increasing the number of veterans and military service members served by
and or engaged in National Service programs
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4. Describe below how your site will address one or more of the community focus areas identified
above. Pay special attention to the specific actions that we measure and how your site will have
measurable outcomes. For example, "Our site addresses the focus area of Education.
Specifically, we prepare economically disadvantaged students for post-secondary educational
institutions. Our AmeriCorps members will serve directly in this area by advising students and
organizing college preparatory workshops."
5. Projects need to be self-sustaining and continue to meet the community needs on or before the
current funding cycle which ends in August 31, 2015. In other words, AmeriCorps members
should not serve your basic staffing needs; you must be able to keep the lights on and keep
operating without AmeriCorps support. How is your project self-sustaining?
6. How does your organization currently engage volunteers, and how do you hope to increase
volunteer engagement with the support of AmeriCorps?
7. How does your organization embrace diversity? How does your organization hope to become
more inclusive of people from varying backgrounds and ability levels with the support of
AmeriCorps?
8. What type of access do you anticipate members having to vulnerable populations while serving
at your site? (Recurring or Episodic?) See appendix for definitions related to criminal history
checks.
9. If your member will have recurring access to vulnerable populations: How will your site meet
the requirement to provide accompaniment for the first 4-6 weeks of the member's term while the
background check is in progress?
Training:
Describe how the site will mentor, train and supervise the member. Include what type of site
orientation the member will receive at your site.
Please share any additional comments, concerns, or information about your site’s service
assignment here:
Time Frame:
Members may complete the bulk of their assignment at different times during the calendar year.
Check all that apply:
Hours will be spread out evenly throughout the year (September 2014 – August 2015)
Hours are flexible and can be changed depending on the member’s availability
This position requires more hours during the school year and limited hours during the summer
This position requires more hours during the summer and limited hours during the school year
Please describe the intended time frame of this position:
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2014-2015 Member Service Assignment Description
Directions: The information provided below is the format to use in writing your position description. You must use this
format. These position descriptions will be used to recruit AmeriCorps members for your specific service
assignment(s). Please include any details that you think apply. You must complete a position description for every
service assignment you propose. If you have more than one service assignment description please copy and paste
the information below for all additional service descriptions you wish to include in this application. If the description is
the same for all requested members please indicate the number of positions that this description applies to at the
bottom.
Short Description of Your Organization and Your Mission:
Position Title:
Reports To (Mentor Name and Title):
Location:
Primary Function / Purpose:
Major Responsibilities and Duties:
Stipend and Other Benefits:
The stipend and education award amounts are listed below:
Full-time (40 hrs/week—1700 hrs total)
Gross Stipend Amount for Term = $12,600; Educational award = $5,550
Eligible for health coverage & Eligible for day care
Half-time (20 hrs/week—900 hrs total)
Gross Stipend Amount for Term = $6,678; Educational award = $2,775
Quarter-time (10 hrs/week—450 hrs total)
Gross Stipend Amount for Term = $3,334; Educational award = $1,468
Minimum-time (6 hrs/week—300 hrs total)
Educational award = $1175; No living stipend provided
Qualifications:
Required:
Preferred:
Training / Development Opportunities:
Work Environment:
Include information about working conditions and any additional requirements for background
screening or requirement to have reliable transportation, etc.
Qualified individuals with disabilities and those from diverse backgrounds are strongly encouraged to
apply. We provide reasonable accommodations for qualified individuals upon request.
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Appendix: National Service Criminal History Information
Federal regulations now require that any AmeriCorps member who has recurring access to
vulnerable populations must be accompanied while they are waiting for their background check to
clear. We will initiate new member background checks at least one week prior to their start date,
but it could take as long as 6 weeks for a member to be cleared to serve without accompaniment.
During that time the mentor and member will need to document on the member's time sheets who
provided accompaniment during every period of time in which the member had access to
vulnerable populations.
Definition of recurring access:
"the ability on more than one occasion to approach, observe, or communicate with, an individual,
through physical proximity or other means, including but not limited to, electronic or telephonic
communication."
Definition of episodic access:
Episodic access is not a regular, scheduled, and anticipated component of an individual's service
activities.
Who is a vulnerable population?
Vulnerable populations include children age 17 or younger, persons age 60 and older, and/or
individuals with disabilities. ‘‘Individuals with disabilities’’ has the same meaning given to the term
in the Rehabilitation Act in 29 U.S.C. § 705(20)(B), and includes any person who has a physical or
mental impairment which substantially limits one or more major life activities, has a record of such
an impairment, or is regarded as having such an impairment.
What is accompaniment?
An individual is accompanied when he or she is in the physical presence of a person cleared for
access to a vulnerable population. One possible way to document accompaniment is to indicate
on the covered individual’s timesheet who did the accompaniment, on what dates, hours, and
have the individual who performed accompaniment incrementally sign off attesting to the accuracy
of the documentation.
Note: accompaniment is a higher standard than supervision and that mere supervision is
inadequate.
Who can provide accompaniment?
Usually it will be the mentor's responsibility to provide accompaniment. Accompaniment can be
performed by an employee or representative of a placement site if that individual’s clearance was
established under the placement site’s rules. Parents and guardians of the vulnerable population
may also perform accompaniment as appropriate for the program design.
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