1 NCCC Project Application

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)

SERVICE PROJECT APPLICATION

APPLICATION INFORMATION

1

Organization Name

Mailing Address

City

State

ZIP

Office Telephone

Ext.

Secondary Sponsor Organization Name

Mailing Address

City

State

ZIP

Office Telephone

Ext.

2

EIN

Secondary Sponsor EIN

3

Organization Type

Community-Based Nonprofit Organization Federal Government Indian Tribe Local Government or Municipality National Nonprofit School State Government

4

Authorized Representative

Organizational Title

Phone Number

Ext.

Email Address

5

Project Site Supervisor

Organizational Title

Phone Number

Ext.

Email Address

PROJECT INFORMATION

6

Project Title

Project Start Date

Fixed or Flexible?

Project End Date

Fixed or Flexible?

Estimated Completed Time (Weeks)

PROJECT FOCUS AREAS AND OBJECTIVES

7

Primary Area of Community Need

Energy Conservation Environmental Stewardship and Conservation Infrastructure Improvement Natural and Other Disasters Urban and Rural Development

8

Disaster Type (if applicable)

Preparedness Mitigation Readiness Recovery

9

Project Objectives

Access to Care At-Risk Ecosystems Awareness and Stewardship Capacity Building and Leverage Community Support Disaster Assistance Provided Education Support Energy Efficiency Engaging Participants Environmental Conservation Financial Literacy Housing Inclusion of People with Disabilities

Other (please specify)

AREAS AFFECTED BY THE PROJECT

10

State or Territory

City or County

State or Territory

City or County

State or Territory

City or County

State or Territory

City or County

OTHER

11

Organization Goals Relevant to the Project

1

2

3

12

Are there any required permits or zoning variances for this project?

Yes No

If ‘Yes,’ please list the specific permits or zoning variances required and state whether you have secured them. Though not required at the time of application, proof of permits may be requested at a later date.

13

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

14

Will the proposed service replace any of your organization’s current or projected staff or contracted labor?

Yes No

15

Could this project be impacted by inclement weather?

Yes No

If ‘Yes,’ do you have sufficient alternate project work opportunities for at least 25% of the project time for the team should there be inclement weather?

Yes No

16

The Corporation for National and Community Service conducts history checks on all members which consists of fingerprint-based FBI criminal history search and a check of the National Sex Offender Public Website (NSOPW.org). Will your organization conduct additional background checks?

Yes No

If ‘Yes,’ please specify what additional background checks are required and how these requirements will be satisfied. If an organization requires additional background checks for AmeriCorps NCCC members, the organization is responsible for fees associated with the background checks and completing background checks prior to or at the start of the project.

17

Does this project include possible exposure of AmeriCorps NCCC members to asbestos, lead paint, hazardous waste, mold, or any other safety hazards?*

Yes No

18

Will members be required to work with potentially hazardous chemicals such as solvents, acids, pesticides, herbicides, adhesives, etc.?*

Yes No

19

Are there any health or environmental conditions that might preclude an AmeriCorps NCCC member from fully participating based on project location or project conditions?*

Yes No

*Selection of ‘Yes’ to this question does not preclude your organization from receiving an AmeriCorps NCCC team. You will need to further explain any hazards or conditions in the Safety and Security Narrative (Question 30).

LOCATIONS

20

Location of Service #1

Primary Site?

Yes No

Organization

Projected Start Date

Projected End Date

Street Address

Address Line 2

City

State

ZIP

Accessible for people with disabilities?

Yes No

Site Supervisor Name

Organizational Title

Phone Number

Email Address

Location of Service #2

Primary Site?

Yes No

Organization

Projected Start Date

Projected End Date

Street Address

Address Line 2

City

State

ZIP

Accessible for people with disabilities?

Yes No

Site Supervisor Name

Organizational Title

Phone Number

Email Address

Location of Service #3

Primary Site?

Yes No

Organization

Projected Start Date

Projected End Date

Street Address

Address Line 2

City

State

ZIP

Accessible for people with disabilities?

Yes No

Site Supervisor Name

Organizational Title

Phone Number

Email Address

*For projects with more than three site locations, please attach a PDF with the information required above for each additional site location.

LODGING SITE #1

21

Lodging Provider

Anticipated Arrival Date

Anticipated Departure Date

Type of Lodging

Apartment or Condo Armory Bed and Breakfast Cabin Campsite Church or Other Faith-Based Organization Community Center Dorm Homestay Hostel Hotel Military Facility NCCC Campus Recreational Vehicle School Room or Classroom Trailer Vacant Home Volunteering Housing Yurt Other

Lodging Category

Community or Faith-Based Organization Federal Government Indian Tribe Institute of Higher Education Local Government or Municipality Military National Nonprofit Organization National or State Park Other

Street Address

Address Line 2

City

State

ZIP

Accessible for people with disabilities?

Yes No

Beds provided?

Yes No

Full Kitchen (including stove and fridge) on site?

Yes No

If no full kitchen, microwave oven on site?

Yes No

Showers on site?

Yes No

Laundry on site?

Yes No

Lodging Contact Name

Phone number

Email Address

Please use the space provided below to further describe team lodging accommodations.

NARRATIVES
Please refer to the application instructions guide for full details on requirements for each section.
22	Executive Summary
23	Need
24	Project Design
25	Project Management
26	Recruitment
27	Member Development
28	Strengthening Communities
29	Organizational Capacity
30	Safety and Security
31	Tools and Equipment

ADDITIONAL QUESTIONS
*	How did you hear about AmeriCorps NCCC?	I am an NCCC alum. I am a past NCCC Sponsor. I am a past NCCC Staff member. From a NCCC alum. From a NCCC Staff member. From a current NCCC member. From a state CNCS office. From an AmeriCorps State or VISTA member. From a community partner. By email. On social media (e.g. Facebook, Twitter, Instagram, YouTube, LinkedIn). On the CNCS Website. Other.
**	Has your organization previously sponsored an AmeriCorps NCCC team?		Yes No
	If ‘Yes,’ how many teams have served with your organization?
	If ‘Yes,’ when did a team most recently serve with your organization?
***	Has your organization ever had a “Fee-for-Service” arrangement with a Youth Corps or Conservation Corps program?		Yes No
****	If ‘Yes,’ AmeriCorps NCCC has effectively been used in past projects to augment and support existing Youth Corps partnerships with organizations. Please describe how you plan to utilize the AmeriCorps NCCC team with your existing partnership with the “Fee-for-Service” Corps.

IMPORTANT NOTICES SECTION

REQUIRED ATTACHMENTS: Supporting documentation is a critical component of the Service Project Application. The supporting materials requested below will help AmeriCorps NCCC Regional staff develop a better understanding of the proposed project during the application review process. Samples and templates are provided for your convenience at XXXXX (TBD). Please include the following documentation when submitting your application.

ON-SITE ORIENTATION: Please attach a comprehensive on-site orientation agenda to your application. This should include an overview of your organization and the project, introductions of the team to the staff of the sponsoring organization(s), tour of the work site(s) and the community, safety and security and a lodging use overview.

TRAINING PLAN: Please attach a training plan outlining the training that members will receive during the project. This plan should include tool training, safety training, and project specific training (e.g., positive youth development, tree identification, roofing instruction, etc.). If a variety of tasks have been proposed in the work plan, the training plan should identify how/when members will be trained to perform the task.

PROJECT WORK CALENDAR: Include a project work plan that outlines the schedule of work. The schedule will assist in planning where a team will perform work, which staff member will work with the team, the assigned task(s) for each work day and the number of members it will take to complete each task. The work plan calendar is an essential part of demonstrating how the organization will provide at least 40 hours of work for each member of the team.

OPTIONAL ATTACHMENTS: The supporting materials requested below are OPTIONAL and will help AmeriCorps NCCC Regional staff develop a better understanding of the proposed project during the application review process.

LODGING PHOTOS: Please provide at least one clearly labeled photo of the proposed team lodging. Strong applications often include photos of team living quarters, kitchen and bath facilities and storage areas for personal belongings.

WORKSITE PHOTOS OR SUPPORTING DOCUMENTS: If feasible, clearly labeled photos of work site tasks, maps of service site locations (e.g. a camp map, trail system map, community housing map, etc.), or similar supporting documentation sometimes can help support the high level of detail you have provided in the Need Narrative and the Project Design Narrative.

ADDITIONAL PAPERWORK REQUIREMENTS: If the Service 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 AmeriCorps NCCC.

SPONSOR AGREEMENT: Once the Service Project Application has been approved, a formal agreement (called a Sponsor Agreement) will be executed between the sponsoring organization and AmeriCorps 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 required to review, approve, and sign the AmeriCorps NCCC Project Completion Report, and return it to AmeriCorps NCCC regional campus staff within five (5) days of receipt.

SURVEYS: Project sponsors and secondary sponsors who have used the services of teams will be asked to complete surveys designed to provide AmeriCorps NCCC with feedback that will inform continuous improvement of services.

DISASTER/FIRE RESPONSE: AmeriCorps NCCC members and staff are part of the Federal Emergency Management Agency (FEMA) and American Red Cross National Disaster Response Network. In addition, AmeriCorps 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 (CNCS) is a self-insured federal agency that administers the AmeriCorps National Civilian Community Corps (NCCC) program. Consequently, AmeriCorps NCCC Corps Members, Team Leaders, and Federal employees of CNCS 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, any injuries or property damage proximately caused by the negligence of an AmeriCorps NCCC Member, Team Leader, or CNCS employee will be assumed by the United States Government, if it is determined that the negligent individual was acting within the scope of his/her official service activity or employment at the time of the potentially compensable event. Similarly, any on-the-job injuries received by an NCCC member or federal employee will be processed by CNCS 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. Neither the Team nor any Team Leader or Corps Member thereof, may legally bind the AmeriCorps NCCC Team or the AmeriCorps NCCC Program.

NON-DISCRIMINATION: A Project Sponsor receiving teams from AmeriCorps NCCC will comply with all federal statutes, including the National and Community Service Act of 1990, as amended, relating to nondiscrimination, which includes nondiscrimination on the basis of race, color, national origin, sex, age, disability, and in most instances, religion. CNCS prohibits all forms of discrimination based on race, color, national origin, gender, age, religion, sexual orientation, disability, gender identity or expression, political affiliation, marital or parental status, or military service. All programs administered by, or receiving Federal assistance from CNCS, must be free from all forms of harassment. 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 CNCS or to any other Federal agency, or any political or inherently religious activities.

SIGNATURE
The Service Project Application MUST be signed by the authorized representative of the sponsoring organization.
SIGNATURE	DATE