Power of We Consortium (PWC)
AmeriCorps State Program
Host Site Application
Program Year 2015-2016
Cover Page
Organization Name:
EIN:
Site Supervisor Name:
Title:
Address:
City/State/Zip:
Telephone Number:
Fax Number:
Email:
We are interested in hosting ____ quarter time AmeriCorps State member(s) at
our organization. We understand each member requires a member host site
match.
Our organization understands and agrees to ALL requirements presented in the Request for
AmeriCorps Member booklet:
Yes
No
Authorization: The applicant certifies to the best of her/his knowledge that this data is true and correct,
that the filing of this application has been duly authorized by the governing body of the applicant and
that the applicant will comply with the assurances required if the proposal is approved.
Name______________________________________
Title_________________________________
Signature ___________________________________
Date ________________________________
This application is for the placement of a 2016 Summer member. Applications are due on January 8th,
2016 by 5p.m. Applications should include page 14 to the end of the document. Please submit
applications to Andrea Villanueva, AmeriCorps State Program Director via email at
avillanueva@ingham.org.
I. Application:
Organizations seeking to host one or more AmeriCorps members may apply by answering the
questions below. Keep in mind that not all reviewers are familiar with these programs.
1. Organizational Information: Briefly describe your organization’s mission and history. If your
organization has hosted or is hosting AmeriCorps members, how many and when?
2. Goal Area: Which of the goal areas will the proposed AmeriCorps member(s) serve?
Healthy Futures
#1. PWC AmeriCorps members will increase the consumption of healthy food and
reduce food insecurity through gardening, food distribution and/or referrals.
#2. PWC AmeriCorps members will teach community members the importance of
eating healthy foods and strategies to adopt better diets.
Describe how the AmeriCorps member(s) will support your organization in addressing the goal(s)
selected above:
3. Target Population: Describe all locations where the AmeriCorps member(s) will likely perform
their duties. Who will be the beneficiaries of the AmeriCorps service?
4. Tracking Outputs: AmeriCorps members are required to produce databases of people served,
which will be fulfilled through the program’s database system. How will you ensure members are
removing duplicates within site? How will you incorporate the AmeriCorps reporting
requirements into your organization’s established reporting systems?
5. Demonstrating Impact: AmeriCorps members are required to gather written community
feedback by surveying the unique individuals they serve. Certain clients will have to be pre and
post surveyed with program specific questions. How will you ensure the collection of survey
results? Once data is collected, how will you determine if AmeriCorps-supported projects have
been successful in impacting the community?
6. Avoiding Duplication: If you are requesting multiple AmeriCorps members, describe how they
would maintain separate and unique roles. Summarize the basic differences between their
duties, characterized by topic, population characteristics, geography, or other factors.
7. Sustainability: If you have hosted AmeriCorps members in the past, how will this service term’s
activities be different? How are you moving towards sustainability? Current member activities
should significantly build upon past projects and/or create new programs for the community.
8. Recruiting Members: It is important to the program that the Lansing community is accurately
represented in the applications submitted as well as the members selected for service. The PWC
program will facilitate program wide recruitment to its networks but does not have the capacity
to reach all host site’s networks. How will your organization aid in member recruitment? Once
selected, how will you ensure that the member at your site is connected to the community he or
she will serve?
9. Choosing Members: PWC Staff plans to coordinate the schedules for all candidate interviews. At
least one PWC staff member and at least the organizations site supervisor must be present at all
interviews. Are you willing to create a joint interviewing session with the AmeriCorps Program?
10. Supervision: Describe how the selected site supervisor is the appropriate choice for member
supervision; describe their role within the organization, time with the program & organization,
connections to the community and other applicable information. How will you and/or the site
supervisor ensure that the member is prepared to overcome challenges in project
implementation?
Additionally, you are required to provide the equipment necessary to complete the duties listed
on the position description. Describe your organization’s capacity to manage the AmeriCorps
member(s), including the provision of adequate desk space with phone/fax/computer/internet
connection.
11. Host Site Match: What funding source will your organization utilize to secure the required host site
match? Include the amount of any unpaid host site match from previous and/or current AmeriCorps
placements. Please note, paying the Host Site match with federal dollars is prohibited, unless you
receive written permission.
II. Position Description:
Include a separate position description for each AmeriCorps member requested using the template
provided on the last 2 pages. Each position description can be no longer than 1 page, and should be
attached to the end of proposal application. Do no remove any text in RED. If the requested
position(s) are awarded, this document will be used to recruit candidates and to structure daily
activities once service begins. Since it is referenced by the AmeriCorps Member Agreement,
members may ONLY do activities listed in the position description. The position description may be
updated after submission if necessary.
Describe the activities each member will perform for your organization. Include the specific daily
tasks of the proposed AmeriCorps member. Tasks should follow the list of approved activities:



Recruitment and mobilization of community volunteers
Community education
Supporting and modeling direct service for community members
III. Budget: Please include a summary of your organization’s annual budget from the previous year.
Power of We Consortium AmeriCorps State Program
Summer Position Description
Position Title:
Category:
Host Site:
Site Supervisor:
AmeriCorps Service Member
Stipend:
$3,200
Position Type:
Quarter time, 450 hours
HR Contact:
AmeriCorps Program Manager
Dates of Service:
April 25 – September 2, 2016
Position Description
Organization Information:
[Type a brief description of your organization if desired.]
Role and Responsibilities:
[Type a description of the essential roles, responsibilities and activities a candidate can expect to assume in this position,
using a Details style description. For additional duties use the Bulleted List style. If travel is required include how much in
description:]
Bulleted list item
Bulleted list item
Minimum Qualification:




Be at least 17 years of age. Minors must have guardian permission. Applicants must have HS diploma, GED or working toward
the completion of one.
U.S. citizen, U.S. national or lawful permanent resident of the U.S.
Pass the following checks: State of Michigan, DHS Central Registry Clearance, FBI Fingerprinting, and State & National Sex
Offender Registry
[Add any additional work experience and educational background that a candidate should have when applying for position.
These requirements should be in addition to the AmeriCorps requirement of having at least a high school diploma/GED upon
starting service. ]
Preferred Skills
[Type a description of any additional skills or experience that would be considered favorable for a candidate who is
applying for this position if applicable.]
Compensation:
Members will receive a living allowance of $3,200 distributed bi-weekly from April 25th-September 2nd, 2016 and receive
student loan forbearance for qualified loans. Upon successful completion of service an education award in the amount of
$1,527.78 will be issued. Members will serve ~25 hours/week. All interested candidates must submit a cover letter and
resume to Power of We Consortium AmeriCorps Program Director, Andrea Villanueva at avillanueva@ingham.org no later
than February 22nd, 2016 by 5p.m.