2 Commitment Form with Signature Line

Segal AmeriCorps Education Award

Matching Program

Commitment Form

Program Purpose: The Segal AmeriCorps Education Award Matching Program provides colleges and universities that match the Segal AmeriCorps Education Award an opportunity to be listed on the Corporation for National and Community Service (CNCS) Website. By participating in the program, colleges and universities benefit by attracting AmeriCorps alumni to enroll in their higher education institutions. AmeriCorps alumni have the traits and skills colleges and universities values, such as a commitment to community, problem-solving experience, and training as leaders. Colleges and universities that offer match to the Segal AmeriCorps Education Award make education more affordable to AmeriCorps alumni who have served their country in local communities across the United States. CNCS encourages all colleges and universities to participate in this program; however, it is not mandatory.

Section I: Profile Information

Name of Higher Education Institution: _____________________________________

If the Segal AmeriCorps Education Award Matching Program applies to a specific department or school, please list here:

Website: _____________________

City, State: ___________________________________________________________

Primary Contact:

Name: _____________________

Phone: ______________________

Fax: ________________________

E-mail: ______________________

Mailing Address: ______________________

President, Provost, or Dean that is signing Commitment Form:

Name: _____________________

Phone: ______________________

Fax: ________________________

E-mail: ______________________

Institution Profile:

Type (please check one):

Public ____ Private _____

Program Types (check all that apply):

2 Year ___ 4 Year ___ Graduate ____

Is Your Institution Eligible to Award Federal Student Aid Funds Based on (check all that apply):

Title IV___ VA Qualified ____

Is Your Institution (check all that apply):

Faith-Based ______ Historically Black College/University _____

Tribal College _____ Hispanic Serving Institution ______

Section II: Commitment Level

Provide a detailed description of what your institution is offering for the Segal AmeriCorps Education Award Matching Program. This language will be posted on our website and should clearly outline your institution’s commitment to AmeriCorps alumni. Include the amount of the dollar match along with any additional benefits that your institution will offer to AmeriCorps alumni.

Please note: Educational institutions must provide a minimum match of $1,000 to be listed on the CNCS website. A dollar for dollar match is the preferred level of commitment from schools that participate in this program.

Percentage of the award that your institution will match for an admitted AmeriCorps alumni: ________%.

Refer to FAQs for an explanation and current amount of the Segal AmeriCorps Education Award. (link to FAQs sheet). The Segal AmeriCorps Education Award is tied to the maximum amount of the U.S. Department of Education’s Pell Grant.

To qualify under the Segal AmeriCorps Education Award Matching Program, AmeriCorps alumni must have successfully completed their full term of service.

*VISTA Summer Associates and AmeriCorps alumni who did not complete service and did not terminate for compelling reasons are not eligible for this program.

Section III: Commitment Timeframe

This commitment to the Corporation for National and Community Service is valid for five (5) years from the date of signature on this agreement. This agreement will be up for renewal on _________.

If the institution needs to terminate this agreement, CNCS will be notified to in order to delete the website listing; otherwise students will continue to contact the institution.

CNCS reserves the right to delete the website listing for any institution not in compliance with the Segal AmeriCorps Education Award Matching Program requirements.

____________________________________________________________________________

Signature

_____________________

Date

Please return this form to: [email protected]

OMB Control No. 3045-0143 Expiration Date 08/31/2015