Host Site Partnership Renewal Form 2016-2017
Please complete to request AmeriCorps Promise Fellows
Overview & Updates for Returning Host Sites
Thank you for your interest in partnering with us again! As you will see, the process is the same as last year. We do want to
highlight one major update! Moving forward we will be expanding the behavior measurement to include disengagement (in
addition to disciplinary tracking). We will be piloting a student engagement tool that sites can administer with a low score
qualifying a student to be on a Focus List. Students will then be able to have their progress in Social-Emotional Learning
core competencies tracked. We will have more information soon, but wanted to share this change now as you think about
the number of students you hope to serve with Promise Fellows!
Host Site Application Process for Returning Host Sites (defined as organizations, schools, districts, non-profit
organizations, government agencies that currently host AmeriCorps Promise Fellows):
 Instead of completing a full host site application, we are asking you, as a returning site, to complete a partnership
renewal form.
 We will accept your forms at an earlier deadline in order to expedite your process and to also give you first access
to our initial applicant pool (expected in late February).
 We encourage you to review your 2015-2016 application to help you complete this partnership renewal form. If
you do not have access to your previous application, please request a pdf version
Partnership Renewal Timeline:
Partnership Renewal Timeline
Who?
Due Date
Submit renewal form, position description, & interview questions
to the Alliance (online renewal form and signed hard copy mailed
to the Alliance)
Host Site
By February 8th, 2016
Application reviewed by team of internal reviewers
Review Team
By February 26th, 2016
Host Site notified of status
Alliance staff
By February 26th, 2016
Host Sites must recruit & hire their Promise Fellow(s)
Host Site
By May 29th, 2016
Completed Host Site Agreement & Cash Match Due
Host Site
By July 15th, 2016
Promise Fellows Begin Serving
Host Site & Promise
Fellow
September 1st, 2016
To assist you in completing the partnership renewal process, please use the following documents:
 Your 2015-2016 Host Site Application
o If you do not have your previous application, you can request that a pdf version be emailed to you
 Partnership Renewal Questions
o We recommend answering the renewal questions below in a word document which can then be cut &
pasted into the online system
 Position Description Template
o Please use the provided templates to submit an updated position description and interview questions
We are here to help! If you have any questions about the process, please be in touch:
 Questions regarding the partnership renewal process, please contact Kori Redepenning
 Questions regarding submitting your partnership renewal form, please contact Annie Himmelsteib
 Questions regarding the required cash match, please contact Julie Muklebust
PARTNERSHIP RENEWAL FORMS are due by February 8th, 2016
Partnership Renewal Questions 2016-2017
FOR RETURNING HOST SITES, WE ENCOURAGE YOU TO USE THE INFORMATION BELOW TO PREPARE YOUR RESPONSES BEFORE SUBMITTING YOUR
FORM AT WWW.MNYOUTH.NET/PROMISE-FELLOWS/HOST. FAXED OR EMAILED APPLICATIONS WILL NOT BE ACCEPTED.
Returning Host Site Contact & Background Information
Host Site Name:
Location/s of where Promise Fellow/s will serve (if known):
Street Address
City
State
Zip
Tax Identification Number of Host Site:
Congressional District for Host Site:
Number of youth in Grades 6-10 served by your organization/school:
Number of Promise Fellows You are Requesting:
Your Cash Match will be:
If the Alliance has additional openings for Promise Fellows, would you be interested in hosting more Fellows than you
requested? If yes, up to how many?
Lead Contact for the status of this partnership renewal:
Email:
Lead contact person's signature, authorizing all information contained in this renewal form (Required for the paper copy):
 Please note that by checking this box, you indicate you authorize all the information contained in this form. Please sign
the hard copy in the box titled “Authorization”
Promise Fellow Supervisor Name/s:
Promise Fellow Supervisor Title:
Promise Fellow Supervisor Email/s:
Data Coach Name/s:
Data Coach Title:
Data Coach Email/s:
Promise Fellow Recruitment Lead Name:
Promise Fellow Recruitment Lead Title:
Promise Fellow Recruitment Lead Email:
Additional Information:
Is your school or school partner designated as a Focus or Priority School by MDE? Yes No
What percentage of the youth served by your school/organization are eligible for free or reduced lunch?
50% or less
More than 50%
Location:
Where do the majority of the youth served by your school/organization live?
 Northern MN: North of 694 to the Canadian Border
 Central MN: Twin Cities Metro Region -- Minneapolis, St. Paul, Burnsville, Woodbury, etc.
 Southern MN: Northfield, Rochester, Marshall, etc.
Partnership Renewal Questions
1. Executive Summary Paragraph
Provide a brief overview of the primary reason for your application:
 Brief overview of your school/organization
 Number of Promise Fellow/s you request
 Anticipated positive shifts the Promise Fellow/s will make in attendance, behavior, and course performance
 How have Promise Fellows been integrated into your school/organization in the past?
 How have Promise Fellows contributed to larger school/organization initiatives of improving school climate,
dropout prevention, increased academic engagement, and/or social emotional learning?
 How is your organization addressing educational equity?
2. Youth Success Team & Focus Lists
Please tell us about the Youth Success Team:
 How long has it been in place?
 Who is on the team and what roles do they play?
 How often does the team typically meet?
 How is data used to inform the work?
Please tell us about your Focus List:
 How will your site use attendance, behavior, and academic data to identify students for the Focus List?
 How will the Promise Fellow collect attendance, behavior, and academic data (please reference supervisor and/or
data coach assistance)
 If you are a community based site, how will student data from partner schools be accessible to Promise Fellow/s
by the start of the service year?
3. Making an Impact
 How has hosting a Promise Fellow/s impacted the youth your organization serves?
 Who are your major partners in this work?
 What difference has a Promise Fellow made to student Attendance, Behavior, and/or Course Performance
outcomes? *Use school, community, or OnCorps data to support your examples*
 In what ways are students demonstrating increased engagement in school and learning?
 How will your Promise Fellow support closing the opportunity gap in Minnesota?
4. Intervention Strategies: Caring Adults, High Quality In and Out of School Support, Service &Leadership
Please reflect on your school/organization’s implementation of the Promise Fellow model:
 What specific Caring Adult, High Quality In School, High Quality Out of School, and Service and Leadership
intervention activities will Promise Fellow/s use to support youth?
 How will adult volunteers be mobilized to serve as caring adults and connected with Focus List students to deliver
interventions?
 What are your plans for providing supports for youth over the summer months (ex. June & July)? What role will the
Promise Fellow have in supporting interventions strategies during summer?
5. Supervision and Support for Fellows
Tell us about your plan for supervision and support for the Promise Fellow/s including:
 How will the Promise Fellow/s be supported?
 How will you ensure that Promise Fellow/s are able to meet their hours of service requirement by the end of
his/her term of service?
 How will you ensure the Promise Fellow/s are able to remain up to date with their data tracking responsibilities?
 Describe lessons learned about supervising and supporting Promise Fellow/s?
 What is your plan to orient and train the Promise Fellow/s to your organization?
 What personal and/or professional activities will be offered to your Fellow/s?
6. Cash Match and In-kind Support
The cash match for each Promise Fellow is $7,200 and must be paid in full by July 15th. Host Sites are also responsible for
in-kind support such as office space, materials, computer/phone, and mileage to required Alliance meetings.
 Describe the sources that will be used to fund your cash match contribution ($7,200 per Fellow) for the 20162017 year.
 Describe the types of in-kind support that will be provided, including a budget for the Promise Fellow and other
resources they will need.
7. Areas of Growth & Improvement
During your recent site visit from Alliance staff, you received a rubric noting your progress in implementing the Promise
Fellow model. Please respond to the following:
 What were areas identified for needing improvement and what plans do you have in place now to address them?
How will your site continue to improve in these areas moving forward?
 If there were no areas of improvement identified, please highlight one or two areas in which you hope to see
growth next year.
*If you have not yet had a site visit yet this program year, please respond to this question once your visit is
complete*
8. Transition Planning
How will your site manage transitions to ensure the Promise Fellow is set up for success? Specifically share the processes
and systems your organization has set up for the following situations:
 Plan for when there are changing members within the Youth Success team
 Plan for when the Promise Fellow supervisor changes from one program year to the next, or during the program
year itself
 Plan for how a new Promise Fellow will be able to carry on the service of Promise Fellow/s who served previously at
your host site
9. Plan for Promise Fellow Recruitment
 Please highlight 5 recruitment efforts your organization will commit to making in order to ensure successful
selection of your Promise Fellow/s by May 29th
 Is there anything that will prevent your organization from starting recruitment in March and/or meeting a May 29th
deadline?
 Please highlight any lessons learned or challenges you faced during Promise Fellow recruitment in 2015-2016
*The 2016-2017 Promise Fellow application is currently live. We highly encourage sites to invest recruitment time
early on to have the greatest access to applicants.*
10. Position Description/s
Using the template provided, please submit an updated Position Description for the Promise Fellow/s. Please limit to 2
pages. The more specific you can be about your site and positions, the better chance you have of finding a candidate who
is a great fit. Think of this document as a marketing tool!
11. Interview Questions
Using the template provided, please submit interview questions that you plan to use for the selection process of your
Promise Fellow/s
PARTNERSHIP RENEWAL CHECKLIST
 Answer all of the above questions and submit your answers
using the online form.
 Upload your Position Description and interview questions to the
online form.
 Mail a signed hard copy to:
Minnesota Alliance With Youth
2233 University Avenue West, Suite 235
St. Paul, MN 55114-1643
PLEASE SUBMIT THE ABOVE BY FEBRUARY 8TH, 2016