Paperwork Burden Notice: The public reporting burden for the collection of this information is estimated to average one hour per submission, including time for reviewing instructions, searching existing data sources, gathering and maintaining data, and completing the form. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, AmeriCorps*NCCC, Attn: Nicholas C. Zefran, 1201 New York Avenue, N.W., Washington, DC, 20525.  The Corporation informs those who may respond to this collection of information that they are not required to respond unless a currently approved OMB control number and expiration date are displayed. (See 5 C.F.R 130.5(b)(2)(i)) 
OMB# - 3045-0005 Exp. Date – 06/30/2011

PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested on the AmeriCorps National Civilian Community Corps Team Leader Application is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended. Purposes and Uses - The information requested is collected for the purposes of reviewing team leader applications. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of AmeriCorps and the Corporation for National and Community Service without prior written permission.  Effects of Nondisclosure - The information requested is not mandatory.  
OMB Control Number                3045-0005

Expiration Date                         TBD

“The Team Leader program brings together citizens of all ages and backgrounds to manage service projects and team members.” 

AmeriCorps National Civilian Community Corps Team Leader Application 
What is the Corporation for National and Community Service?
The mission of the Corporation for National and Community Service (CNCS) is to improve lives, strengthen communities, and foster civic engagement through meaningful service and volunteering. Each year, the Corporation provides opportunities for approximately two million Americans of all ages and backgrounds to serve their communities and country through Senior Corps, AmeriCorps and Learn and Serve America. The AmeriCorps programs engage 75,000 men and women each year in service to meet community needs. 
What is AmeriCorps NCCC? 
The National Civilian Community Corps (NCCC) is one of three AmeriCorps programs of the Corporation for National and Community Service.  The NCCC is a residential national service program that engages teams of 10 to 12 members on service projects that address critical needs related to natural and other disasters, infrastructure improvement, environmental stewardship and conservation, and urban and rural development.
 
What is the AmeriCorps NCCC Team Leader program? 
The Team Leader program seeks citizens of all ages and backgrounds who want to serve their country in a leadership capacity. Team Leaders are responsible for the day to day activities of 18 to 24 year old team members and the projects that they perform.
How are Team Leaders compensated? 
In exchange for an 11 to 12 month commitment, Team Leaders receive a living allowance of $12,500, room and board, and limited health and child care benefits.  Like NCCC members, Team Leaders receive a post-service education award which is currently $5,550 following the successful completion of their term of service. The amount of the education award can change annually as it is tied to the pell grant. 
What do Team Leaders do? 
The Team Leader manages the day-to-day activities of 10 to 12 members, ages 18 to 24, from diverse backgrounds and experiences.  He or she serves as a supervisor, a role model, facilitator, an educator, and encourages high standards for members involved in community-based service projects.  The Team Leader reports directly to a Unit Leader. 
Who can be a Team Leader? 
NCCC seeks applicants with prior supervisory and leadership experience in communities, schools, the Peace Corps, AmeriCorps and youth corps programs, the U.S. military, and other organizations that support service or individual development goals. 

Applicants should have experience working with young adults and a high degree of patience, flexibility, and adaptability. The Team Leader position is a demanding job that requires long and intense hours. Applicants must be prepared for many challenges and be willing to make an 11 to 12 month commitment. As a residential team-based program, the Team Leader is required to travel, work, and live with their team during their term of service.

Where do Team Leaders serve? 
NCCC Team Leaders serve at one of several regional campuses. Please refer to www.americorps.gov/nccc for campus locations and contact information. 
How can you apply to be a Team Leader? 
Complete an NCCC Team Leader paper application or apply online at https://my.americorps.gov prior to the deadline for each program year and cycle. For more information or an application, contact the NCCC Team Leader program at the Corporation for National and Community Service at 1-800-942-2677.  
Who is eligible? 
You must be at least 18 years old.  You must be a U.S. citizen, U.S. national, or lawful permanent resident alien. You must have an acceptable driving record and a valid driver’s license.

AmeriCorps National Civilian Community Corps Team Leader Position Description 
What is AmeriCorps NCCC? 
The National Civilian Community Corps (NCCC) is one of three AmeriCorps programs of the Corporation for National and Community Service.  The mission of the Corporation for National and Community Service (CNCS) is to improve lives, strengthen communities, and foster civic engagement through meaningful service and volunteering. Each year, the Corporation provides opportunities for approximately two million Americans of all ages and backgrounds to serve their communities and country through Senior Corps, AmeriCorps and Learn and Serve America. The AmeriCorps programs engage 75,000 men and women each year in service to meet community needs. The NCCC is a residential national service program that engages teams of 10 to 12 members on service projects that address critical needs related to natural and other disasters, infrastructure improvement, environmental stewardship and conservation, and urban and rural development.
 
POSITION OVERVIEW
The AmeriCorps National Civilian Community Corps (NCCC) Team Leader manages the day-to-day activities of 10 to 12 members, ages 18 to 24. He or she serves as a supervisor, a role model, facilitator, and educator, and encourages high standards for members involved in community-based, service projects.  The Team Leader reports directly to a Unit Leader. 
DUTIES AND RESPONSIBILITIES 
•	Leadership: Supervise, motivate, direct, and coordinate a team of young adults in a structured program of service, education, and training; maintain order; maintain positive team dynamics; foster teamwork; monitor and enforce standards of behavior; ensure the safety of members, including the proper use of equipment; model a good work ethic and serve alongside members to set the pace. 
•	Project Management: Manage service-learning projects, locally or on spikes. A “spike” is a service project where teams establish temporary living arrangements for up to two months in the community where they are serving.  Team Leaders will serve on spike projects away from their assigned campus approximately 80 percent of their term of service.  Spike housing can vary and may include church basements, wilderness camping in the backcountry, small houses and large FEMA camps during disaster responses. Plan daily and weekly team schedules that will result in the execution of project objectives and activities. 
•	Coach: Assist and support member development through regular assessment and goal setting. Ensure the development of good work habits on site as well as career and interpersonal skills off site. Assist and support members in the development of leadership skills. Identify and nurture leadership opportunities at the service project site and otherwise. Support residential life experience through conflict mediation, crisis intervention, counseling, etc. 
•	Supervisor: Coordinate project logistics with Unit Leaders and project sponsors; participate in staff meetings as appropriate; and serve as programmatic and administrative liaison between members and staff. Conduct regularly scheduled team meetings designed to unify team members by building consensus,

negotiating, resolving conflicts, and providing structured feedback. Oversee the care, safety and well-being of the team members. Monitor and ensure cleanliness of living quarters, uniform appearance, quiet hours, and adherence to all NCCC policies.  Enforce policy and maintain program standards at all times.
•	Trainer: Facilitate, encourage, support, and integrate service-learning models in all aspects of project implementation.  Conduct or coordinate training such as skill-building workshops, safe work practices, team-building exercises, mini-courses, project sponsor orientation and trainings, project briefings and debriefings, and physical conditioning. 
•	Administrator: Manage budget for spikes and submit written reports on project progress, achievements, and accomplishments; member evaluations; and special activities or incidents. Maintain daily records, leave of absence requests, service forms, etc.  Coordinate production of all project documentation.  Manage federal vehicles and ensure safe operations at all times.
•	Outreach: Represent the NCCC and the Corporation for National and Community Service in local communities, to the media, and other stakeholders. Oversee and manage team specialty roles regarding recruiting and outreach to potential Corps Members. 

SUPERVISORY ROLE 
The Team Leader, working closely with their assigned Unit Leader, accomplishes daily tasks as assigned. Potentially difficult or controversial problems are referred to a Unit Leader for guidance, advice, and resolution. Team leaders are evaluated on day-to-day activities, achievement of service project objectives, supervisory skills, serving as a positive model for team members, interaction with others, accountability for policy and other compliance requirements, soundness of judgment, and timeliness of action. 
KNOWLEDGE, SKILLS, AND ABILITIES
 
•	Ability to supervise, establish and maintain proper standards, organize, and motivate a team of diverse 18 to 24 year-old young adults from widely varying backgrounds and experiences. 
•	Willingness to learn and apply leadership principles, facilitate small group dynamics, conduct team building, problem-solving, decision making, communication, counseling, and conflict management skills. 
•	Interpersonal skills that will facilitate growth and development of positive team dynamics. 
•	Manage teams to perform high quality service projects. 
•	Understanding of and willingness to abide by and enforce all NCCC policies and procedures. 
•	Understanding of privacy principles and willingness to observe member confidentiality. 
•	Good driving record with a valid driver's license. Able to implement safe driving practices and monitor the driving habits of Member drivers.  Driver safety training will be provided. 
•	Flexibility and willingness to adapt to communal living, long work hours, a highly structured program, and limited free time. 

LIVING ALLOWANCE AND EDUCATION AWARD 
Team Leaders receive a living allowance of $12,500, room and board, and limited health and child care benefits during the term of service. Like NCCC members, Team Leaders will receive a post-service education award of $5,550 following successful completion of the program. The amount of an educational award can change on an annual basis as the amount is tied directly to the Pell grant.

AmeriCorps National Civilian Community Corps Team Leader Application 
Please type or print all information. 
I. CONTACT INFORMATION 
PERMANENT ADDRESS 
Name: __________________________________________________________________________________ Street Address: __________________________________________________________________________ City/State/Zip Code: ______________________________________________________________________ Home Phone: __________________________ Cell Phone: ______________________________________ 
CURRENT ADDRESS (if different from permanent): 
Street Address: __________________________________________________________________________ City/State/Zip Code: ______________________________________________________________________ 
Day Phone: __________________________ Cell Phone: ________________________________________ 
E-Mail Address: ____________________________________________________________________________ Social Security Number: _______________________  Date of Birth: ________________________________ 
II. EDUCATION 
Check the highest level of education you will have completed by the time you begin your service year in AmeriCorps (check only one). List all schools you have attended, including high schools, trade or technical schools, military training and employment training programs.

■ Some high school 			■ Associate’s degree  		■ Bachelor’s degree 
■ High school diploma or GED 		■ Some college 			■ Graduate degree 
■ Technical school/apprenticeship 	■ Other (please specify): __________________________________ 

Name of School (List most recent first) 	Location 	Dates Attended From To MO/YR MO/YR 	Major or Area of Study 	Degree Received or Expected 	

					

Name of School (List most recent first) 	Location 	Dates Attended From To MO/YR MO/YR 	Major or Area of Study 	Degree Received or Expected 	

					

					

					

III. EMPLOYMENT HISTORY 
Attach a current resume of professional experience(s) you have had beginning with the most recent.  For each position your resume should include employer's name, address, and phone number, a description of the job, your supervisor, dates employed, and your reason for leaving. If your resume summarizes your educational and national and community service background, it is not necessary to include this information on a separate attachment as requested in Parts II and IV. 
IV. NATIONAL AND COMMUNITY SERVICE BACKGROUND 
Attach a list of the part or full-time service program(s) where you have served.  List any additional community service or volunteer work you have been involved with starting with the most recent.  List the organization, your position and duties, dates of service, and the volunteer supervisor and contact information, if possible. If this information is included as a part of your resume, it is not necessary to submit a separate attachment. 
V. REFERENCES 
Distribute the attached reference forms to two people who are familiar with your skills, interests, and are able to describe how you and NCCC will benefit from your participation in the Team Leader program.  At a minimum, references should include: 1) a supervisor from an employment or service experience; 2) a peer from school or an employment or service experience or a teacher, professor, member of the clergy or other person who can attest to your character.  Each reference must return the completed form to you in a sealed envelope.  All sealed references must be enclosed with your application. 
VI. PERSONAL STATEMENTS 
Please prepare answers not more than 500 words each that respond to the following topics and attach them to your application. 

•	Describe your leadership, supervision, or teaching experiences; the challenges you experienced and what you learned from these experiences. 
•	Explain how your participation as a Team Leader will strengthen the NCCC, what you hope to gain from this experience, and how the Team Leader experience will further your personal and professional goals. 

VII. LEGAL 

Existence of a criminal conviction may or may not, depending on the circumstances, disqualify you from consideration. However, any intentional misrepresentation or omission will disqualify you. 
Have you ever been convicted of any violations other than minor traffic violations?              ■ Yes ■ No 
If yes, for what have you been convicted, when and where? 
Do you have any pending charges or are you under any type of criminal investigation?         ■ Yes ■ No 
If yes, please explain: 
Are you now on probation or parole?                                                                                 	■ Yes ■ No 
If yes, please provide the name, address, and phone number of the judge, probation or parole officer we can contact to verify the above information. 
Name _________________________________________ Phone ___________________________________ Address _________________________________________________________________________________ 
You may attach any additional information or explanation on a separate sheet. 
VIII. CERTIFICATION 
Are you a U.S. citizen, a U.S. national, or a lawful permanent resident alien?                        ■ Yes ■ No 
IX. CERTIFICATION 
I certify that all of the statements made in this application are true, correct, and complete to the best of my knowledge and that they are made in good faith. I understand that this information may be provided to sponsoring organizations or grantees to determine appropriate placement, the Department of Treasury for preparing support checks; the Social Security Administration for reports and contributions, federal investigative agencies for background investigations, and to other organizations involved in the application evaluation process. 
Signature__________________________________________  Date_________________________________ 
OPTIONAL INFORMATION: 
This information will be used for statistical purposes only and will not impact the selection process. Completion of this section is voluntary and failure to respond will in no way affect your candidacy. 
How did you hear about AmeriCorps? (You may check more than one.)

■ Armed forces 		
■ College guidance office/placement office 	■ Department of Education 	
■ Friend/relative 	■ High school guidance counselor 	
■ Internet/listserv/e-mail 	■ Newspaper/magazine article 	
■ Newspaper/magazine advertisement 	■ Peace Corps 	
■ Other service organization 	■ Radio advertisement 	
■ Radio story 	■ Received information in the mail 	
■ Television advertisement 	■ Television news story 	
■ Poster at school 	■ Other (specify):_________________________________ 	

What is your gender? 		■ Female ■ Male 
What is your ethnicity? 		■ Hispanic or Latino ■ Not Hispanic or Latino 
What is your race? Select one or more. 

■ 	American Indian/Alaskan Native. A person having origins in any of the original people of North and South America (including Central America) and who maintains tribal affiliation or community attachment. 
■ 	Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. 
■ 	Black or African American. A person having origins in any of the black racial groups of Africa. 
■ 	Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 
■ 	White. A person having origins in any of the original people of Europe, the Middle East, or North Africa. 

AmeriCorps National Civilian Community Corps TEAM LEADER REFERENCE FORM 
Strengthening communities and developing leaders through team-based national and community service 
Applicant’s Name _________________________________________________________________________ 
To the individual providing the personal reference: AmeriCorps engages thousands of young people in a year of full-time service that is results driven and promotes citizenship skills.  Projects are community-based and sponsored by local and national nonprofit organizations, and city and state agencies.  AmeriCorps members help communities meet critical challenges in the areas of education, public safety, the environment, disaster relief, and other unmet community needs. In return, AmeriCorps members earn education awards that help pay for college or pay back student loans.  The person named above is applying to be an AmeriCorps National Civilian Community Corps Team Leader.  The Team Leader manages and supervises the day-to-day project-related activities of 10 to 12 team members, ages 18 to 24. The applicant has indicated that you are able to evaluate his or her qualifications and provide us with candid recommendations. Your input is greatly appreciated. 
Name of Individual Providing the Reference __________________________________________________ Position/Title___________________________________ Organization ______________________________ Address __________________________________________________________________________________ City, State, Zip____________________________________________________________________________ Phone__________________________________________ E-mail __________________________________ 
KNOWLEDGE OF THE APPLICANT 
How long have you known the applicant? Years________ Months________ 
In what capacity have you known the applicant?
 
■ Job Supervisor/Employer 	■ Clergy 		■ Volunteer Supervisor        ■ Coach 
■ High School Teacher 		■ College Instructor 	■ Peer/Colleague 
■ Other (specify):___________________________________ 

WORK PERFORMANCE 
Consider such qualities as dependability, initiative, and the ability to work with minimal supervision. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
LEADERSHIP 
Consider the applicant’s ability to supervise and manage others (i.e. delegate, discipline, and achievement of project goals). 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
INTERPERSONAL COMMUNICATION 
Consider such qualities as understanding other people’s viewpoints and problems and ability to communicate with people of different ages and backgrounds; and relationships with colleagues, supervisors, and people in general. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
MATURITY 
Consider such qualities as the ability to work under pressure, adaptability, and good judgment. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
OVERALL RECOMMENDATION 
What is your overall recommendation? 
■ I recommend the applicant without reservation as an excellent candidate. 
■ I recommend the applicant as a good candidate. 
■ I have some reservation, but I believe the applicant has a reasonable chance of success. 
■ I have substantial doubts about the applicant's ability to perform these functions. 
■ I do not recommend this applicant. 

ADDITIONAL COMMENTS _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
CONFIDENTIALITY STATEMENT 
■ 	I AUTHORIZE the program and/or the Corporation for National and Community Service to identify me as the source of this reference and to release a copy of this reference in its entirety upon request to the applicant. 
■ 	I DO NOT authorize the program and/or the Corporation for National and Community Service to identify me as the source of this reference, nor do I authorize the release of a copy of this reference in its entirety to the applicant. I realize that a summary of this information may be released without my approval. 

Your Signature____________________________________________  Date___________________________ 

PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested on the AmeriCorps National Civilian Community Corps Team Leader Application is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended. Purposes and Uses - The information requested is collected for the purposes of reviewing team leader applications. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of AmeriCorps and the Corporation for National and Community Service without prior written permission.  Effects of Nondisclosure - The information requested is not mandatory.  
OMB Control Number                3045-0005

Expiration Date                         TBD

AmeriCorps National Civilian Community Corps TEAM LEADER REFERENCE FORM 
Strengthening communities and developing leaders through team-based national and community service 
Applicant’s Name _________________________________________________________________________ 
To the individual providing the personal reference: AmeriCorps engages thousands of young people in a year of full-time service that is results driven and promotes citizenship skills.  Projects are community-based and sponsored by local and national nonprofit organizations, and city and state agencies.  AmeriCorps members help communities meet critical challenges in the areas of education, public safety, the environment, disaster relief, and other unmet community needs. In return, AmeriCorps members earn education awards that help pay for college or pay back student loans.  The person named above is applying to be an AmeriCorps National Civilian Community Corps Team Leader.  The Team Leader manages and supervises the day-to-day project-related activities of 10 to 12 team members, ages 18 to 24. The applicant has indicated that you are able to evaluate his or her qualifications and provide us with candid recommendations. Your input is greatly appreciated. 
Name of Individual Providing the Reference __________________________________________________ Position/Title___________________________________ Organization ______________________________ Address __________________________________________________________________________________ City, State, Zip____________________________________________________________________________ Phone__________________________________________ E-mail __________________________________ 
KNOWLEDGE OF THE APPLICANT 
How long have you known the applicant? Years________ Months________ 
In what capacity have you known the applicant?
 
■ Job Supervisor/Employer 	■ Clergy 		■ Volunteer Supervisor        ■ Coach 
■ High School Teacher 		■ College Instructor 	■ Peer/Colleague 
■ Other (specify):___________________________________ 

WORK PERFORMANCE 
Consider such qualities as dependability, initiative, and the ability to work with minimal supervision. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
LEADERSHIP 
Consider the applicant’s ability to supervise and manage others (i.e. delegate, discipline, and achievement of project goals). 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
INTERPERSONAL COMMUNICATION 
Consider such qualities as understanding other people’s viewpoints and problems and ability to communicate with people of different ages and backgrounds; and relationships with colleagues, supervisors, and people in general. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
MATURITY 
Consider such qualities as the ability to work under pressure, adaptability, and good judgment. 
■ Exceptional 	■ Above Average      ■ Average      ■ Below Average 
Provide a brief justification for your rating:____________________________________________________ 
OVERALL RECOMMENDATION 
What is your overall recommendation? 
■ I recommend the applicant without reservation as an excellent candidate. 
■ I recommend the applicant as a good candidate. 
■ I have some reservation, but I believe the applicant has a reasonable chance of success. 
■ I have substantial doubts about the applicant's ability to perform these functions. 
■ I do not recommend this applicant. 

ADDITIONAL COMMENTS _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
CONFIDENTIALITY STATEMENT 
■ 	I AUTHORIZE the program and/or the Corporation for National and Community Service to identify me as the source of this reference and to release a copy of this reference in its entirety upon request to the applicant. 
■ 	I DO NOT authorize the program and/or the Corporation for National and Community Service to identify me as the source of this reference, nor do I authorize the release of a copy of this reference in its entirety to the applicant. I realize that a summary of this information may be released without my approval. 

Your Signature____________________________________________  Date___________________________ 

PRIVACY ACT NOTICE: The Privacy Act of 1974 (5 U.S.C § 552a) requires that the following notice be provided to you: The information requested on the AmeriCorps National Civilian Community Corps Team Leader Application is collected pursuant to 42 U.S.C 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service Act of 1973 as amended. Purposes and Uses - The information requested is collected for the purposes of reviewing team leader applications. Routine Uses - Routine uses may include disclosure of the information to federal, state, or local agencies pursuant to lawfully authorized requests. In some programs, the information may also be provided to federal, state, and local law enforcement agencies to determine the existence of any prior criminal convictions. The information may also be provided to appropriate federal agencies and Department contractors that have a need to know the information for the purpose of assisting the Department’s efforts to respond to a suspected or confirmed breach of the security or confidentiality or information maintained in this system of records, and the information disclosed is relevant and unnecessary for the assistance. The information will not otherwise be disclosed to entities outside of AmeriCorps and the Corporation for National and Community Service without prior written permission.  Effects of Nondisclosure - The information requested is not mandatory.  
OMB Control Number                3045-0005

Expiration Date                         TBD

Please inform your campus(es) where you applied immediately if your contact information such as mailing address, phone number, or e-mail address changes. 
Corporation for National and Community Service AmeriCorps NCCC 1201 New York Avenue, NW Washington, D.C. 20525 1-800-942-2677 202 606-3472 - TTY www.americorps.gov/nccc