Form 1 NCCC Project Sponsor application

SERVICE PROJECT

APPLICATION PACKET

Insert Campus and Campus contact info

Insert Project Name Here

JOIN WITH AMERICORPS NCCC

TO GET THINGS DONE IN YOUR COMMUNITY

OMB Version info inserted here

AmeriCorps NCCC (National Civilian Community Corps) is part of AmeriCorps, a network of national and community service programs that engage 75,000 Americans each year in intensive service to meet critical needs in the areas of natural and other disasters, infrastructure improvement, environmental stewardship and conservation, energy conservation and urban and rural development. The NCCC is a team-based, full-time, residential program for men and women between the ages of 18 and 24. Members are based at regional campuses in several states.

Since 1994, more than 18,000 people have served in AmeriCorps NCCC, providing assistance to hundreds of thousands of Americans. Members serve in diverse teams of 8 to12 individuals and are assigned to projects in their regions.

Corporation for National and Community Service

AmeriCorps NCCC

1201 New York Avenue, NW, 10th Floor

Washington, DC 20525-0001

202-606-5000 (800-833-3722 TTY)

The Corporation for National and Community Service improves lives, strengthens communities, and fosters civic engagement through service and volunteering. Each year, the Corporation provides opportunities for Americans of all ages and backgrounds to serve their communities and country through Senior Corps, AmeriCorps, and the Social Innovation Fund. This year, more than two million Americans will serve through those programs to help thousands of national and community nonprofit organizations, faith-based groups, schools, and local agencies meet local needs in education, the environment, public safety, homeland security, and other critical areas. National and community service programs work closely with traditional volunteer organizations to broaden, deepen, and strengthen the ability of America's volunteers to contribute not only to their communities, but also to our nation.

Upon request this material will be made in alternative forms for people with disabilities.

Burden Notice: The collection of this information is authorized by the provisions of the National and Community Service Act, as amended by the National and Community Service Trust Act of 1993. This agency informs the potential persons who may respond to the collection of information that such persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Estimated time to complete this application, including time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information is 7 hours. If you have any comments regarding this collection of information, send them to: Corporation for National and Community Service, AmeriCorps NCCC, 1201 New York Avenue, NW, Washington DC 20525-0001, phone 202-606-5000.

Privacy Act Notice: The collection of this information is authorized by 42 USC § 12617. The information is intended for use by AmeriCorps NCCC in determining whether or not to support a specific project. Non-public information provided will not be disclosed outside the Corporation for National and Community Service without written permission from the applicant. Information provided for this collection may be shared with federal, state, and local agencies for law enforcement purposes. While providing the information is voluntary, failure to disclose the requested information could affect the applicant's eligibility for project selection.

OMB#3045-0012 • Expires 3/31/13

Table of Contents

Introduction 1

cover page 1

americorps nccc and the corporation for national & community service 2

table of contents 3

introduction to americorps nccc 4

americorps nccc members 4

americorps nccc service projects 4

service project application process 6

service Project concept form (New sponsors only) 7

service project application (New sponsors only) 9

project information 9

primary project work site information 11

co-sponsoring agency information 11

project plan 12

1. Mission and Objectives of your Organization 12

2. Project Work Plan and Tasks 12

3. Community Involvement 14

4. Accommodations 14

5. Member Development 15

6. Tools, Equipment, and Personal Gear 16

7. Security, Safety, and Medical Considerations 16

8. Permits 17

9. Project Summary 17

application review and agreement 18

important notices 18

signature 19

appendix 20

sample inclement weather work plan 20

sample work plan 21

sample on-site orientation & training plan 24

SERVICE PROJECT UPDATE FORM 25

AMERICORPS NCCC

The AmeriCorps NCCC (National Civilian Community Corps) is a full-time, residential, national service program that combines the best practices of civilian service with the best aspects of military service. The mission is to strengthen communities and develop leaders through team-based national and community service. Each year, hundreds of young adults serve as NCCC members. Based at campuses in communities in several states, teams take on projects throughout their regions. Members help communities meet needs in the areas of natural and other disasters, infrastructure improvement, environmental stewardship and conservation, energy conservation, and urban and rural development.

Teams are available to help community and faith-based based organizations, national nonprofits, schools, local municipalities, national and state parks, and Indian tribes. Members help citizens prepare for and respond to natural and other disasters, construct and rehabilitate low-income housing, build and repair trails, lead and manage community volunteers, support academic achievement of students, and address other local needs. Service projects typically last from six to eight weeks. Because members are trained in disaster services and wild land fire fighting, they can be reassigned on short notice to support disaster relief operations.

AMERICORPS NCCC MEMBERS

Members are young men and women, 18 to 24 years old, representing a wide variety of socio-economic, cultural, geographic, and educational backgrounds. They include those with graduate degrees and some who are working on their high school equivalency diplomas.

All members have earned their place on an NCCC team by demonstrating a commitment to serve their community, to develop practical skills, and to make the nation stronger through a year of hard work. The rewards for their service include an increased understanding about how effective and active citizenship can make a positive difference in the lives of others and build stronger communities, technical and interpersonal skills that will serve them well in the future, and an education award that will enable them to continue their education or reduce educational debt.

AMERICORPS NCCC SERVICE PROJECTS

The NCCC accomplishes its mission by working with local community organizations and groups to help them meet needs that they have identified and that would not be fully addressed without additional assistance. Potential project sponsors are required to submit a Project Application that outlines project goals and activities. Approved Project Applications must meet the following criteria:

• Address compelling community needs

• Have clearly stated and well planned tasks and objectives

• Have demonstrable, measurable goals

• Engage all team members in meaningful service throughout the project

• Provide opportunities for member growth and development

• Involve the community throughout the project

• Have a plan for sustainability after the team completes its service

Projects are normally six to eight weeks in duration, but will vary depending on the requirements of the project. Projects must be capable of using at least one full team of 8 to 12 members effectively. Transportation and some basic tools are provided by the NCCC; however, project sponsors are required to provide materials, specialized tools, orientation, training, and technical supervision. The project sponsor is responsible for arranging housing for the team, and works with the NCCC to arrange for meals, and other logistical needs. Some campuses have limited housing available to projects within a reasonable driving distance of the campus. Inquire with your campus.

Service projects address community needs in the following program areas:

Natural and Other Disasters

Natural and Other Disaster projects address the needs of communities affected by floods, hurricanes, wildfires and other disasters. The focus is on preparedness, mitigation, response and recovery projects. Examples of projects include, but are not limited to: coordinating volunteers; managing distribution centers and shelters; preparing and distributing meals; clearing debris; enrolling victims into emergency-assistance databases; mucking and gutting; surveying community assets; distributing educational materials and preparedness kits; implementing disaster-preparedness curricula; mapping for improvements to community emergency response systems; and installing hurricane shutters.

Infrastructure Improvement

Infrastructure Improvement projects contribute to the safety and well being of community members through repairing and building structures. In addition, projects will improve basic facilities and services needed for the functioning of the community. Examples of projects include, but are not limited to: building wheelchair ramps; establishing community centers; assembling playgrounds; repairing and painting public facilities.

Environmental Stewardship and Conservation

In the tradition of the Civilian Conservation Corps of the 1930s, Environmental Stewardship and Conservation projects help preserve and enhance a community’s natural resources. Examples of projects include, but are not limited to: trail development and maintenance; planting trees; removing invasive plant species; cleaning up rivers, streams, and beaches; performing water quality assessments; and leading environmental education workshops and camps for youth.

Energy Conservation

Energy Conservation projects promote energy efficient practices with organizations, communities, families, or individuals. Examples of projects include, but are not limited to: providing energy efficiency assessments; assisting with installations of energy efficient appliances and light bulbs; developing recycling programs; performing home weatherization projects for low-income, disabled, and senior citizens; and providing and developing educational programming on sustainability and conservation practices.

Urban and Rural Development

Urban and Rural Development projects address the special needs of communities in ways that improve the quality of life for citizens and the success of whole communities. Examples of projects include, but are not limited to: supporting homeless shelters, food banks, youth and family service organizations; historical preservation; programming for seniors and special populations; renovating and constructing homes; leading neighborhood and community revitalization projects; and providing direct service to students, parents, and families through tutoring, one-on-one assistance, afterschool programming, employment counseling and health awareness.

SERVICE PROJECT APPLICATION PROCESS

The sponsor application process for an AmeriCorps NCCC team is a three-step process. The first step is filling out the one-page Service Project Concept Form. The second step is submitting the full Project Application. The third step is the application review and approval, which is completed by NCCC Staff.

STEP 1: COMPLETE THE SERVICE PROJECT CONCEPT FORM

• Service Project Concept Form completed and submitted to the regional Program Office. Regional Program Office Information is found on the last page of the Project Application.

• Upon review of the Concept Form, the regional Program Office will notify the organization of its status. The organization should not complete the full project application until instructed to do so by the regional NCCC Program Office. The Concept Form is available online at www.americorps.gov/nccc or through the regional Program Office.

• It is preferred that Concept Form be completed and submitted electronically. Electronic signatures are acceptable.

• Answer each question as fully as possible.

• Contact the regional Program Office with any questions.

STEP 2: SUBMIT THE APPLICATION

• The Project Application should be submitted 2 to 4 months prior to the preferred start date of the project. Contact your regional Program Office for specific deadlines.

• The project sponsor is encouraged to include any supplemental information (brochures, reports, etc.) that will assist in the understanding and evaluation of the Project Application.

• Electronic signatures are preferred and acceptable.

• The Project Application may be sent via email, mail or fax to the regional Program Office.

STEP 3: APPLICATION REVIEW

• The regional Program Office will contact the project sponsor to discuss the Service Project Application and next steps in the process.

Projects Sponsors applying for more than one project in a program year should complete the three-step process above for the first project. For any subsequent projects they should complete a Project Update Form (in the Appendix) and follow the two-step process below.

STEP 1: SUBMIT THE PROJECT UPDATE FORM

• The Project Update Form should be submitted 2 to 4 months prior to the preferred start date of the project. Contact your regional Program Office for specific deadlines.

• The project sponsor is encouraged to include any supplemental information (brochures, reports, etc.) that will assist in the understanding and evaluation of the Project Update.

• Electronic signatures are preferred and acceptable.

• The Project Update may be sent via email, mail or fax to the regional Program Office.

STEP 2: APPLICATION REVIEW

• The regional Program Office will contact the project sponsor to discuss the Service Project Update Form and next steps in the process.

AmeriCorps NCCC

Service Project Concept Form

This form will help AmeriCorps NCCC determine if the organization’s project concept meets the basic criteria for a service project. Upon review, the regional Program Office will notify the organization of its status and the next steps in the Project Application process.

Please attach additional pages as needed to fully complete every question.

1. Organization Name: __________________________________________________________

Organization Representative: ___________________________________________________

Mailing Address: ____________________________________________________________

City/State/Zip:

Telephone: ______________ Fax: ______________ Email: _______________________

Website: ___________________________________________________________________

2. Provide a brief description of your organization's mission.

3. Provide a brief description about the service activities for which your organization is requesting a NCCC team. Please conclude your statement with the desired outcome expected from the involvement of NCCC.

4. Provide the address where the service activities will take place if different from the organization address above.

Address: ___________________________________________________________________

City, State, & Zip Code: ______________________________________________________

5. Check the box for the primary issue area that the project will address.

□ Natural and Other Disasters □ Environmental Stewardship and Conservation

□ Infrastructure Improvement □ Energy Conservation

□ Urban and Rural Development

6. How many teams are being requested? ________________________________________

How many weeks will it take a team of 8 to 12 members working full-time (40-45 hours per week) to complete this project? ____________________________

Proposed Beginning Date: ________________ Proposed End Date: ___________________

These dates are □ Fixed or □ Flexible

7. What is your organization type? Check all that apply.

□ National Non-Profit □ Local Municipality □ National or State Park

□ Community or Faith-Based □ Indian Tribe □ Federal Government

□ School □ State Government

□ Other (please specify): ______________________________________________________

8. In the event that housing is not available on the regional campus or your project is beyond a reasonable driving distance (1hr) from your regional campus, briefly describe the housing arrangements you are exploring for the team.

9. Have you worked with a NCCC team previously? □ Yes □ No

If ‘Yes’, how many teams have served your organization? __________

If ‘Yes’, when did a team most recently work with your organization? __________________

10. Do you currently or have you ever had a "Fee for Service" arrangement with a youth corps or conservation corps program?* (Fee for Service is defined as an agreement in which your organization pays fees or reimburses costs to a service program in exchange for member or team support). □ Yes □ No

*NCCC has effectively been used in past projects to augment and support existing youth corps partnerships with organizations. Please describe how your plan to utilize NCCC will incorporate your existing partnership with the "Fee for Service" corps.

11. How did you find out about the NCCC? (check all that apply)

□ I am an NCCC Alum □ I am a past NCCC Sponsor

□ NCCC Staff Member □ NCCC Alumni □ Current NCCC Member

□ State CNCS Office □ Outreach Presentation □ Previous NCCC Project Sponsor

□ State Commission Community Service Office

□ Other (please list): ____________________________________________________________

_______________________________________ ___________________________

Signature Date

AmeriCorps NCCC

Service Project Application

PROJECT INFORMATION

Sponsoring Agency/Organization: __________________________________________________

Co-Sponsoring Agencies: ________________________________________________________

Sponsor Representative: _____________________________

Position/Title: _____________________________________

Mailing Address: _______________________________________________________________

City/State/Zip:

Office Telephone: _________________ Fax: _______________ E-mail: __________________

Alternate Phone Numbers:_____________________ Website:___________________________

How many teams are being requested? __________

How many weeks will it take a team of 8 to 12 members working full-time (40-45 hours per week) to complete this project? ________________

Proposed Beginning and End Dates: __________________

Dates are □ Fixed or □ Flexible

What is your organization type? Check all that apply.

□ National Non-Profit* □ Local Municipality □ National or State Park

□ Community or Faith-Based* □ Indian Tribe □ Federal Government

□ School □ State Government

□ Other (please specify): _________________________________________________________

* Attach confirmation of non-profit status.

Is your organization currently funded wholly or in part by the Corporation for National and Community Service?** □ Yes □ No

If ‘Yes’, is the proposed project funded by an AmeriCorps State and National grant or any AmeriCorps VISTA resources?** □ Yes □ No

**If you answered ‘Yes’ to either of the above questions, please provide detailed information concerning the funding source and utilization of those funds.

Could the proposed project be accomplished with contracted labor?*

□ Yes □ No

If ‘Yes’, does your organization currently have the resources to pay for contracted labor?

□ Yes □ No

Will the proposed service replace any of your organization's current or projected staff?

□ Yes □ No

What is your organization's annual budget? (Check only one box; if part of a national affiliate please check the box appropriate to your chapter or local organization’s budget))

□ Less than $150,000 □ $500,000 - $999,999

□ $150,000 - $299,999 □ $1,000,000 - $4,999,999

□ $300,000 - $499,999 □ $5,000,000 and above

Is this an □ Urban □ Suburban □ Rural or □ Wilderness area?

Please use the following criteria when identifying your geographic area:

• Urban projects are in heavily populated areas or cities of 50,000 or more residents.

• Suburban communities represent the residential areas right outside of urban areas but do not themselves consist of 50,000 or more.

• Rural projects occur in areas that do not meet the population requirements of urban and suburban areas; usually small towns and communities.

• Wilderness projects occur in unpopulated or sparsely populated areas where human contact is very limited.

P

The project is required to provide a site supervisor. The site supervisor is the individual in charge of daily activities who serves as a liaison for the team and is available on site to respond to team needs. The site supervisor should possess the awareness, experience, and technical competence to address the project's safety and technical issues.

RIMARY PROJECT WORK SITE INFORMATION

1. Project site address

Street Address_______________________________________________________________

City/State/Zip:_______________________________________________________________

2. Mailing address if different from site address

Street Address_______________________________________________________________

City/State/Zip:_______________________________________________________________

3. Site Supervisor Name: __________________________ Title: _________________________

Cell Phone: ______________________ Site Telephone: _____________________________

Fax: _____________________ E-mail: __________________________________________

4. Please describe the accessibility of the work site for persons requiring mobility, vision or hearing accommodation. If the work site is wheelchair accessible please describe the accessibility to include the work area and restrooms.

5. Please identify available phones, fax, computer or internet access that can be made available to the team for official team business and project-related purposes.

CO-SPONSORING AGENCY INFORMATION

a) Site mailing address: __________________________________________________________

City/State/Zip: ______________________________________________________________

b) Site Supervisor Name:____________________________ Title: _______________________

Cell Phone: ______________________ Site Telephone: _____________________________

Fax: _____________________ E-mail: __________________________________________

PROJECT PLAN

1. MISSION AND OBJECTIVES OF YOUR ORGANIZATION

a) Describe the overall mission of your agency. This should include a brief history of the organization, an explanation of the organization's mission and how it fulfills this mission through its various programs.

b) Describe the community need that will be addressed by this project. This may include poverty rates, education levels, or general assets and challenges facing the community, which relate to the project.

c) Describe how the proposed project will help to meet these needs. What will be the final outcome(s) of services provided?

A detailed work plan is an essential element of successfully conducting a project. The project must engage all team members in meaningful service throughout the duration of the project. Members must be engaged a minimum of 40 hours a week to complete their service obligation. A final, comprehensive and detailed work plan will be required before the project is approved and a team assigned.

Inclement weather can shut down scheduled project activities. The sponsor is required to have a work plan for inclement weather. The inclement weather plan may include service opportunities with other sponsors such as eligible non-profits, schools or local government agencies within a reasonable driving distance.

2. PROJECT WORK PLAN AND TASKS

1. List the specific tasks and activities that the team will perform.

2. Provide a project work plan including: (See Appendix for Sample Work Plans A and B)

• The tasks to be accomplished during each week of the service project.

• An estimate of the number of members required to complete each task.

• A calendar that shows the sequence of activities throughout the duration of the project.

• Top work priorities to accomplish if an NCCC team is called away to disaster before their full work term is completed.

• Back-up projects in case the team completes the assigned work early, or unexpected circumstances prevent execution of the original project plan.

• Could this project be impacted by inclement weather? □ Yes □ No

3. If inclement weather could impact the project, please provide an inclement weather work plan that includes: (See Appendix for Sample Inclement Weather Plan)

• Inclement weather service tasks in the sequence in which they will be addressed. This plan could be with a partner organization.

• The address, phone number and site supervisor at the inclement weather project site (if different than regular project site address).

4. AmeriCorps NCCC will be serving with your organization for a relatively short period of time. How are you going to maintain and continue to build upon NCCC’s work after a team has left?

5. NCCC records the activities and outcomes from every project. This is accomplished by recording information such as the numbers of people served, pounds of food collected, houses renovated, and other measurable accomplishments. At the end of every project, sponsors also complete an online survey about the project.

Please select the Issue Areas and Objectives that apply to this project.

• Issue Areas – Check all that apply

□ Natural and Other Disasters

□ Infrastructure Improvement

□ Environmental Stewardship and Conservation

□ Energy Conservation

□ Urban and Rural Development

• Objectives – Check all that apply

□ Access to Care

□ At-Risk Ecosystems

□ Awareness and Stewardship

□ Capacity Building and Leverage

□ Community Support

□ Disaster Assistance Provided

□ Education Support

□ Energy Efficiency

□ Engaging Participants

□ Environment

□ Financial Literacy

□ Housing

□ Individuals Assisted

□ Infrastructure Improvement

□ K-12 Success

□ Obesity and Food

□ Post-High School Education Support

□ Public Safety

□ Veterans and Families Served

□ Other (please describe):________________________________________________

3

Leveraging and working cooperatively with community volunteers is a national service priority. Project Applications with a strong community involvement component will be given priority.

. COMMUNITY INVOLVEMENT

1. Describe how the community is already involved in helping to meet the stated needs of the organization. Please describe all current forms of support including funding, volunteers, donation of materials, and government or private grants that contribute to your program’s operations.

2. How many volunteers support your organization on a weekly basis? Please describe your volunteer outreach efforts.

3. How would an NCCC team increase your organization’s capacity to engage more volunteers in your work? Consider any community events during the project that NCCC could support.

4. How will you publicly recognize this NCCC partnership? Examples might include recognizing it via social/print media, through radio interviews, or at community events.

4

The project sponsor must provide, and pay for if necessary, lodging for the team. (Some campuses have limited housing available to projects within a reasonable driving distance of the campus. Inquire with your campus.) When teams are housed by the sponsor, this is called a “spike” project. An application is considered incomplete and a team can not be assigned until appropriate housing has been identified. Providing food and/or meals is encouraged, but not required in order to receive a team.

Accommodations should be responsive to the following requirements:

• Adequate space for 8-12 members with separate female and male sleeping facilities

• Access to bathroom, shower, and laundry facilities

• Availability of cooking and food storage facilities or meals provided by sponsoring agency

• Possible special dietary arrangements that may accommodate vegetarians, if food will be prepared for the team (many members do not eat meat or dairy products)

• Safety and security of members, their personal belongings, and equipment

. ACCOMMODATIONS

a) Please provide a detailed explanation of the provided accommodations addressing the requirements above and including a detailed description of the following with photos or web links where available:

• Location of the housing

• Type of housing, i.e. house, apartment, church, camp, etc.

• Number of sleeping rooms, including the number of beds in each room if applicable

• Number of bathrooms

• Location of laundry facilities (onsite or laundry mat)

• Access to kitchen facility or a food and meal plan including availability of kitchen cookware and table settings

• Accessibility for persons with mobility, vision or hearing accommodation requirements. Provide specific details on wheelchair accessibility.

• Housing supplies/equipment NCCC will need to supplement (cots, cookware, bedding/linen, tents, camping stove and cookware)

2. Describe the project area climate, geography and provide any information the team needs to know to prepare for their stay. If project site and housing locations differ, please describe both.

3. Are there additional cultural, recreational, educational experiences and/or options for physical training that your organization can make available to the members during the course of the service project? If so, please specify.

5

It is intended that through orientation, training and the project tasks, members will acquire an in-depth understanding about what they are doing and why it is important to the community. This methodology is called service-learning. Project sponsors work closely with NCCC staff and members in the design, support and implementation of training, orientation, and other service-learning opportunities. At least one full day should be dedicated to project orientation.

If members are required to operate dangerous tools and equipment such as skillsaws, chainsaws, augers, forklifts, tractors and other construction machinery to achieve project goals, then training must be provided by the project sponsor. NCCC staff will work with the project sponsor to develop and coordinate special training requirements before team deployment.

. MEMBER DEVELOPMENT

1. Pre-Project Training: Describe the necessary pre-project training that the members should receive at the NCCC regional campus before arrival at the project.

2. On-Site Orientation and Training: Provide a comprehensive and detailed development and training plan regarding on-site orientation and training that the members will receive at the project. Orientation and training should include: (See Appendix for Sample On-Site Orientation & Training Plan)

• Overview of your organization and the project

• Goals and objectives of the project

• Introductions of the team to the staff of the sponsor organization

• Tour of the work site(s) and the community

• Safety orientation and training, including a statement regarding how the project will meet the Occupational Safety and Health Administration (OSHA) standards

3. Other Service-Learning Opportunities: Describe other learning opportunities related to the project work that could help members enhance their overall knowledge, acquire life skills, and help them acquire an in-depth understanding about what they are doing and why it is important to the community. This could include guest speakers, videos, community events, background documents, discussion of the mission of your organization, information about the larger social issues associated with the project, and new skills the team members will likely develop.

6. TOOLS, EQUIPMENT, AND PERSONAL GEAR

1. What equipment, tools, and storage facilities will your organization provide?

2. What equipment and tools are requested from the NCCC to supplement the local supply?

3. Please identify any safety hazards associated with the tools and equipment that will be used on the project. Be sure to provide details of any safety training that will be provided and by whom in the overall orientation and training plan. (Section 5 paragraph b.)

4. What personal equipment and clothing should the team bring? (For example, inclement weather gear, boots, sun protection, hats and gloves).

7

The Corporation, with the assistance of the U.S. Office of Personnel Management Federal Investigative Services Division, conducts criminal background checks on all NCCC members.

The NCCC has safety guidelines that address member safety on the project site. Copies of these guidelines are available from the regional campus. The site supervisor should be present on-site with the team daily during the team’s working hours. The site supervisor should possess the awareness, experience, and technical competence to address the project's safety and technical issues.

Appropriate personal protective equipment (respirators, gloves, goggles, etc.), as well as a properly trained and certified on-site supervisor must be provided by the project sponsor.

. SECURITY, SAFETY, AND MEDICAL CONSIDERATIONS

1. Will members be subjected to any additional background checks? □ Yes □ No

If ‘Yes”, please specify what additional background checks are required, as well as how these requirements will be satisfied.

2. Does this project include possible exposure of members to asbestos, lead paint, hazardous waste, or any other safety hazards? □ Yes □ No

If ‘Yes’, please provide required documentation to ensure the project meets OSHA standards as related to asbestos, lead paint, lead removal, hazardous waste, and other potential safety hazards.

3. Will members be required to work with potentially hazardous chemicals such as solvents, acids, pesticides, herbicides, adhesives, etc.? □ Yes □ No

If ‘Yes’, the Material Safety Data Sheets (MSDS) for each chemical should be available on-site.

4. Many cleaning solvents and commonly used construction materials such as adhesives, oil-based paints, brush cleaners, and thinners have hazardous components. Even though the product itself is not considered toxic or hazardous, these components can give off fumes, irritate skin, or cause other uncomfortable conditions. Please describe such products here.

5. Are there other situations that could result in difficult or uncomfortable conditions for members such as extreme weather, allergies, phobias, ticks, poison ivy or poison oak, etc.?

□ Yes □ No

If ‘Yes’, please specify and include reference information that will prepare members to work safely in that environment.

6. Are there any common health conditions that might preclude an NCCC member from fully participating based on project location or project conditions? □ Yes □ No

If ‘Yes’, please specify those health conditions.

7. List any required or recommended immunizations.

8. Identify local medical facilities, including address, telephone number, hours of operation, distance from the project site, and team lodging and local emergency response procedures (i.e. 911 response).

9. Identify any other potential safety considerations associated with the project.

8. PERMITS

1. Have work permits and other legal permissions specific to the project been secured?

□ Yes □ No □ N/A

If ‘No’, please indicate the date they will be obtained.

9. PROJECT SUMMARY

1. Please provide a concise summary of this project in 250 words or less, including the need(s) to be addressed, the tasks to be accomplished, and the expected benefits to the community and to the NCCC members. This response should summarize information already found in other parts of the application. If a team is assigned to the project, this summary may be used for internal and external purposes such as websites or media materials.

AmeriCorps NCCC

Application Review and Agreement

IMPORTANT NOTICES

ADDITIONAL PAPERWORK REQUIREMENTS: If the Project Application is approved and teams perform the service project, the project sponsor will be required to review and sign two additional documents: the Sponsor Agreement and the Project Completion Report. Sponsoring organizations will also be asked to complete a survey to capture their evaluation of their partnership with the NCCC.

• SPONSOR AGREEMENT: Once the Project Application has been approved, a formal agreement (called a Sponsor Agreement) will be executed between the sponsor organization and the NCCC, which will specify the roles, responsibilities, and contributions of both parties. Teams cannot begin work on the project until this agreement is approved by signature by both parties.

• PROJECT COMPLETION REPORT: After the project is completed the project sponsor will be asked to review and approve the NCCC Project Completion Report, and return it to the regional Program Office within five (5) days of receipt.

• SURVEYS: Project sponsors who have used the services of teams will be asked to participate in surveys designed to provide the NCCC with feedback that will inform continuous improvement of services.

DISASTER/FIRE RESPONSE: NCCC members and staff are part of the Federal Emergency Management Agency (FEMA) and American Red Cross National Disaster Response Network. In addition, the NCCC assists local, state, and national forest services with wildfire suppression. Potential project sponsors should note that in the event of a natural disaster or homeland security crisis, members may be recalled from projects to serve as part of the relief efforts. This could result in a decrease in the number of members assigned to your project, a delay in the deployment of a team, or cancellation of a project.

LIABILITY AND WORKERS' COMPENSATION CLAIMS: The Corporation for National and Community Service (Corporation) is a self-insured federal agency. Consequently, members and federal employees of the NCCC are covered by the provisions of the Federal Tort Claims Act (liability claims) and the Federal Employees Compensation Act (workers' compensation claims) 42 U. S. C. §12620 (b) & (c). Accordingly, the United States Government will assume responsibility for any injuries or property damage caused by the negligence of a member or an employee who was acting within the scope of his/her employment. Similarly, any on-the-job injuries received by an NCCC member or federal employee will be processed by the Corporation and the Department of Labor.

WAIVERS: No member of an AmeriCorps NCCC Team (including any Corps Member or Team Leader) shall sign any document provided by the Project Sponsor or any representative or employee of the Project Sponsor, including but not limited to: liability waivers, hold harmless agreements, indemnification agreements, or employment-related documents. In the event that a member of an AmeriCorps NCCC Team signs a document provided by the Project Sponsor or any representative or employee of the Project Sponsor, the signature on any such document shall have no force or effect of law.

NON-DISCRIMINATION: Under federal law, a project sponsor receiving assistance from the NCCC may not unlawfully discriminate on the basis of race, color, national origin, religion, sex, age, political affiliation, or disability (for otherwise qualified individuals). Corporation for National and Community Service policy also prohibits discrimination on the basis of sexual orientation, marital or parental status, military service, and social affiliations. Project sponsors will be required to sign an assurance of non-discrimination as part of the Sponsor Agreement.

SERVICE PROJECT LIMITATIONS: In the course of performing a service project, members cannot engage in any project assignments that involves direct fundraising, financial transactions, preparation of a grant application to the Corporation or to any other Federal agency, or any political or inherently religious activities.

SIGNATURE

The Service Project Application must be signed by a representative of the sponsoring organization. An electronic signature will be accepted.

___________________________________ ____________________________

Project Sponsor Signature Date

AmeriCorps NCCC

Appendix

SAMPLE INCLEMENT WEATHER WORK PLAN

Inclement Weather Days 1-3 (East Tennessee):

• Paint trail signs.

• Repair roof on equipment trailer.

• Organize & inventory our equipment cage at the Knoxville field office.

• Assist with indoor stewardship project at Roan Mountain State Park – interior or spring cleaning at the historic Millers Homestead. Site supervisor will be Park Manager Pat Gagan.

• Assist with indoor stewardship project at Norris Dam State Park - interior painting/fall cleaning of the Nature Center. Site supervisor will be Park Ranger Alison Humble.

Inclement Weather Days 4-6 (Middle Tennessee):

• Paint and making trail signs. (this will involve the entire team)

• Assist with indoor stewardship project at Cumberland Mountain State Park- interior painting/spring cleaning of the Nature Center. Site supervisor will be Park Ranger Monica Johnson. (this will involve the entire team)

SAMPLE WORK PLAN

SAMPLE ON-SITE ORIENTATION & TRAINING PLAN

AmeriCorps NCCC

S ervice Project Update Form

The Service Project Update Form is to be completed by organizations who have already submitted a full Service Project Application during the current program year. This form confirms essential project information submitted initially in your application. Sponsors are asked to submit this form in order to be considered for project rounds beyond the round for which the original application was submitted. A separate update is requested for each round.

Please submit this form by the application deadline date of the round for which you request a team.

Organization Name: _______________________________________________

Sponsor Representative Name: ____________________________________________

Sponsor Representative Title: ____________________________________________

Is this the same Sponsor Representative as listed on the original application? □ Yes □ No

If ‘No’, please list changes to representative’s contact information:

Email: ____________________________________________

Phone: ___________________________________________

For which round are you requesting a team? (Please specify only one round) _____________

What dates are you requesting the team? ___________________________________________

These dates are □ Fixed or □ Flexible

How many teams are you requesting? ______

1. WORK PLAN AND SCHEDULE (please refer to Section 2 of your original application)

   1. How is the work plan different from the original application?

Please submit an updated work plan listing all changes to the scope of work, dates and new tasks:

2. Is the work site supervisor the same as listed in the original application? □ Yes □ No

If ‘No’, please list the new name and contact information:

3. Please describe any special events affecting the team (e.g. Building Blitz, Collegiate Challenge, National Service Day project, etc) and their dates during this upcoming round:

2. HOUSING (please refer to Section 5 of your original application)

   1. Is the housing the same as listed in the original application ?

□ Yes □ No

If ‘No’, please list any changes, (e.g. new address, capacity, change in meal plan, etc):

2. Have you contacted the facility to confirm availability during the next round?

□ Yes □ No

3. ADDITIONAL NOTES

IMPORTANT: Please reread your original application. Describe below any other changes to the project or your organization. This is where changes to sections not specified above (i.e. training, tools, hazardous materials, etc.) should be described. Otherwise we will assume that all information in the original application applies to the next round.

OMB#3045-0012 • Expires 3/31/13

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