Corporation for National and Community Service
Application for Support
I. To register in the system
Salutation
Mr.
Ms.
Mrs.
Dr.
Miss
Preferred Name
First Name
Middle Name
Last Name
Suffix
Primary Phone
Is this a Mobile Number?
Yes
No
Would you like to receive texts?
Yes
No
Secondary Phone
Re-Enter Email
II. To create an organization
Organization Information
EIN
DUNS #
Legal Name
Name(d.b.a)
Organization Type
Federal Government
For Profit Organization
Higher Education Organization – Private
Higher Education Organization – State
Indian Tribe
Local Government – County
Local Government – Municipal
Local Government – Township
National non-profit
Native American
Non-Profit
Other
State Education Agency
State Government
U.S. Territory
Unknown Designation
Phone
Organization Characteristics
Governor’s Office
State Commission/Alt Admin Entity
State Education Agency
Other State Government
U.S. Territory
Local Education Agency
Local Affiliate of National Org
Statewide Association
Community Action Agency/Prog
Tribal Government Entity
Tribal Organization (NGO)
National Non-Profit (Multi-State)
Other Native American Organization
Vocational/Technical College
Historically Black College/Univ. (HBCU)
Hispanic-Serving College/Univ.
Community College
2-Year College
4-Year College
Tribally-controlled College/Univ.
School (K-12)
Area Agency on Aging
Chamber of Commerce/Bus. Assn.
Community-Based Org.
Service/Civic Organization
Volunteer Management Org.
Law Enforcement Agency
Health Department
Self-Inc. Senior Corps Project
Faith-based organization
Local Government, Municipal
Geographic Focus – Rural & Urban
21st Century Conservation Service Corps
Professional Corps
Other Initiative
Organization Contact Information
Street Address 1
Street Address 2
City
State
Zip
Phone
Organization Email
III. To create a project
Project Name
Organization
Project Title
Project State
Project Site URL
Street Address 1
Street Address 2
City
State
Zip
Phone
Project Director
IV. Notification of Intent to Apply
A. Organization & Contact Information
Organization Name
Organization City
Organization State
Contact Person
Contact Person Email
B. Focus Area of Application
Disaster Services
Economic Opportunity
Education
Environmental Stewardship
Healthy Futures
Veterans and Military Families
Capacity Building
Other
Estimate Total # of Applications
Intended Focus Area
Youth Development
Economic Opportunity
Healthy Futures
Type of Applicant Organization
Governor-appointed State or Territory Service Commission
All Other Organizations (Not a State or Territory Service Commission)
Federally-recognized Indian Tribe
Tribal Organization or not a Federally-recognized Indian Tribe
Grant Making Institution
Eligible Partnership
Nonprofit Organization
Public or Nonprofit University
State or Local Government
Indian Tribe
Faith-based Organization
Partnership of the Above Organizations
Type of Application
Single-State*
Continuation**
AmeriCorps Indian Tribe Opportunity***
None of the Above****
Day of Service Funding Opportunity
Martin Luther King Jr. Day of Service
September 11th National Day of Service and Remembrance
Both
My Organization
Nonprofit Organization
Public or Nonprofit University
State or Local Government
Tribe
Faith-based Organization
My Partner Organization
Nonprofit Organization
Public or Nonprofit University
State or Local Government
Tribe
Faith-based Organization
V. Application
A. Project Information
Standard 424 Option
Project Name:
Project Director:
Project Website URL
Proposed Start Date:
Proposed End Date:
B. Areas Affected by Project
Areas Affected by Project Option
State (pick list):
Counties (pick list):
Other
Other
EO 12372 Process
Yes
No
If Yes, Please Explain
Applicant Delinquent on any Federal Debt
Yes
No
If “Yes,” provide your explanation here
State Application Identifier
Have resource history with any CNCS org?
Yes
No
VISTA Other
Program Type (pick list)
Standard
Program Grant
Support Grant
Cost Share (pick list)
Yes
No
NCCC
(All) Other
How many teams are being requested?
1
Number of weeks to complete project
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
Select a round
NCCC (Traditional) Other
Disaster Type
Preparedness
Readiness
Mitigation
Response
Recovery
Firefighting
Fire Management
Could contracted labor be used?
Yes
No
Funds available for contracted labor?
Yes
No
Will the project replace staff?
Yes
No
Impacted by inclement weather?
Yes
No
Additional background checks
Yes
No
Describe additional background checks
Any possible exposure to safety hazards?
Yes
No
Any potentially hazardous chemicals?
Yes
No
Possible Health Restrictions
Yes
No
Project Permissions & permits secured
Yes
No
NCCC (Traditional Disaster Response) Other
Disaster Type
Response
Firefighting
Any possible exposure to safety hazards?
Yes
No
Any potentially hazardous chemicals?
Yes
No
Possible Health Restrictions
Yes
No
Project Permissions & permits secured
Yes
No
NCCC (Partner) Other
Partner Project Code
Request Priority
Low
Medium
High
Team
Mobility
Low
Medium
High
Disaster Number
Funding Code
Disaster Type
Preparedness
Readiness
Mitigation
Response
Recovery
Firefighting
Fire Management
Any possible exposure to safety hazards?
Yes
No
Any potentially hazardous chemicals?
Yes
No
Possible Health Restrictions
Yes
No
S&N Program 1 Other
Other Revenue
Question 1
Question 2
S&N Program 2 Other
Question 1
Question 2
S&N CSG Other
# current voting commission brd mbrs
# mbrs of largest prty rep’d on cmmssion
SIF Other
Focus Area
Geographic Focus
Issue Focus
Senior Corps Other
Number of episodic volunteers
Number of ongoing volunteers
D. Narratives
Clarification Summary
Amendment Justification
Continuation Changes
Executive Summary
Project Design
Need
Strengthening Communities
Recruitment and Development
Project Management
Organizational Capability
Tools and Equipment
Cost Effectiveness and Budget Adequacy
Safety and Security
Evaluation Summary or Plan
Intermediary Justification
Research and Evaluation Design
VISTA Assignment
Other
E. Focus Areas and Objectives
Education
Teacher Corps
Post-HS Education Support
K-12 Success
School Readiness
Other Education
Veterans and Military Families
Access & Attract
Veterans & Families Served
Other Veterans
Disaster Services
Disaster Assistance Provided
Other Disaster Services
Environmental Stewardship
At-Risk Ecosystems
Awareness & Stewardship
Energy Efficiency
Green Jobs
Other Environmental Stewardship
Healthy Futures
Access to Care
Aging in Place
Inclusion of people w/ disabilities
Obesity and Food
Other Healthy Futures
Capacity Building
Capacity Building & Leverage
Other Capacity Building
Economic Opportunity
Asset Building
Community Economic Development
Employment
Financial Literacy
Find Opportunity
Housing
Microenterprise
Other Economic Opportunity
Energy Conservation
Awareness and Stewardship
Energy Efficiency
Housing
Environmental Stewardship and Conservation
At-Risk Ecosystems
Awareness & Stewardship
Environmental Conservation
Infrastructure Improvement (pick list):
Community Support
Inclusion of People with Disabilities
Infrastructure Improvement
Natural and Other Disasters
Access to Care
At-Risk Ecosystems
Capacity Building & Leverage
Disaster Assistance Provided
Housing
Public Safety
Urban and Rural Development
Access to Care
Community Support
Education Support
Financial Literacy
Housing
Inclusion of People with Disabilities
Other Healthy Futures
Public safety
Other
F. Demographics
Target Populations (pick list):
Adult ESL participants
Adults
Caregivers
Children in Foster Care
Disadvantaged youth (K-12)
Families experiencing homelessness
Formerly Incarcerated Adults
Formerly Incarcerated Youth
Head Start participants
Immigrants and refugees
Individuals experiencing homelessness
Low-income communities
Low-income Hispanic/Latino
Low-income Nat-Amer./Nat-AK/Pac-Islander
Multi-focus Intermediary
None of the above
Parents
People in hospice for terminal illness
People receiving mental health services
People receiving substance abuse service
People with physical/mental disabilities
People with HIV/AIDS
Senior Citizens
Students, general
Teachers
Unemployed individuals
Veteran family members
Veterans
Victims/Survivors of violence and abuse
Youth (16-24) not in school or working
Youth ESL participants
Characteristics and Priorities
Issue Focus
Geographic Focus – Urban
Geographic Focus – Rural
21st Century Conservation Service Corps
Promise Zones
Strong Cities/Strong Communities
Governor and Mayor Initiative
Encore program
Professional corps
National Guard
Healthy State & School Ready to Learn
Summer Learning Loss Prevention
Reading at Grade Level by Third Grade
Keeping Kids on Track/Giving 2nd Chances
STEM program
STEM/Maker Community
Summer Programs
SIG/priority school
Together for Tomorrow
High School Ready for College & Career
Minority Serving Institutions /HBCUs
4-H / Land Grant
Technology Programs
Community Colleges
My Brother's Keeper/ Youth Opportunity
Successfully Entering the Workforce
Philanthropically Underserved
Multi-focus Intermediary
Human Trafficking
Public Infrastructure projects
Intergenerational programming
Evidence based programming
G. Location (AmeriCorps National Operating Sites, NCCC Project and Lodging Sites, VISTA Project Sites, Senior Corps Stations
Location Type
Operating Site
Service Location
Member Lodging
Inclement Weather Site
Location Name
Active
Supervisor Name
Supervisor Email
Supervisor Organization
Supervisor Phone Number
Supervisor Phone Number Extension
Undisclosed Location
Yes
No
Street Address 1
Street Address 2
City
State
Zip
EIN Information Option
Location EIN
Site Date Information Option
Projected Start Date
Projected End Date
Accessible for people with disabilities
Description of Accessibility
Site Type Option
Station Type
Adult Correctional Facilities
Juvenile Correctional Facilities
Area Agency on Aging
Before and After School Care
Chambers of Commerce
Community and Economic Development Organizations
Food Security
Pre-School Day Care
Head Start
Developmental Disability Organizations
Home Health Organizations (public and private non-profit)
Hospitals/Medical Centers/Clinics
Environmental Stewardship Organizations
Residential Long Term Care/Nursing Homes/Rehabilitation/Hospice
Libraries
Senior Centers/ Adult Day Care
Public Housing
Parks/Recreational Agencies
Museums
Native American Schools
Mental Health Programs (non-residential)
Police/Law Enforcement/Courts
Post-Secondary Institutions
Private School K-12
Public School K-12
Teen Pregnancy/Teen Parenting Programs
Veterans Hospital/Organizations Serving Veterans
Vocational Training
Faith-based Stations/Volunteers
Transitional Shelters/Centers (e.g. homeless, abused, other short-term)
Service Organizations (Lions, Elks, etc.)
Other (Please specify in text box)
Other Station Type
Additional Operating Site Option—AmeriCorps National Operating Sites Only
CNCS Funds Requested
Slots
School Information Option—AmeriCorps National Operating Sites Only
Is this a K-12 School?
Yes
No
National Center for Education Statistics ID
Volunteer Information Option—Senior Corps Stations Only
Number of Volunteers
Number of Unduplicated Volunteers
Veterans Served
Yes
No
Focus Area and Objectives Option—NCCC and VISTA Project Sites Only
Education
Teacher Corps
Post-HS Education Support
K-12 Success
School Readiness
Other
Other Education
Veterans and Military Families
Access & Attract
Veterans & Families Served
Other
Other Veterans and Military Families
Disaster Services
Disaster Assistance Provided
Other
Other Disaster Services
Healthy Futures
Access to Care
Aging in Place
Other
Other Healthy Futures
Environmental Stewardship
At-Risk Ecosystems
Awareness & Stewardship
Energy Efficiency
Green Jobs
Other
Other Environmental Stewardship
Capacity Building
Effectiveness & Efficiency
Capacity Building & Leverage
Scale/Reach
Other
Other Capacity Building
Economic Opportunities
Asset Building
Community Economic Development
Employment
Financial Literacy
Find Opportunity
Housing
Micro-enterprise
Other
Other Economic Opportunities
Site Type and Summer Associates Option—VISTA Project Sites Only
Site Type
Performance Measurement
Member Placement
Both
Summer Associates
Yes
No
Lodging Information Option
Lodging Type
Apartment or Condo
Armory
Bed and Breakfast
Cabin
Campsite
Church or Other Faith-Based Center
Community Center
Dorm
Homestay
Hostel
Hotel
Military Facility
NCCC Campus
Other
Recreational Vehicle
School Room or Classroom
Trailer
Vacant Home
Volunteer Housing
Yurt
Lodging Category
Community or Faith-Based Organization
Federal Government
Indian Tribe
Institute of Higher Education
Local Government or Municipality
Military
National Non-Profit Organization
National or State Park
Other
Other School
Private Company
Private Individual
State Government
Lodging Description
Lodging Arrival Date
Lodging Departure Date
Beds Provided
Laundry
Kitchen
Refrigerator & Microwave
Shower
Distance to Location of Service
H. Budget
Section |
Subsection |
Object Class |
Line Item Name |
|
|
|
|
Section I - Direct Costs |
IA. Operating/Support Costs |
Personnel |
(Applicant-defined) |
|
|
|
Supervisor |
|
|
Fringe Benefits |
(Applicant-defined) |
|
|
|
FICA |
|
|
|
Health Coverage |
|
|
|
Life Insurance |
|
|
|
Retirement |
|
|
Travel |
(Applicant-defined) |
|
|
|
Travel to CNCS-Sponsored Meetings |
|
|
|
Local Travel |
|
|
|
Long Distance Travel |
|
|
Equipment |
(Applicant-defined) |
|
|
Supplies |
(Applicant-defined) |
|
|
Contractual |
(Applicant-defined) |
|
|
|
Payroll Processing |
|
|
|
Legal Services |
|
|
|
Audit Services |
|
|
|
Meeting and Conference Management |
|
|
|
Consultant |
|
|
Training |
(Applicant-defined) |
|
|
Evaluation |
(Applicant-defined) |
|
|
Criminal Background Checks |
(Applicant-defined) |
|
|
Other Costs |
(Applicant-defined) |
|
IB. Member/Volunteer Costs |
Member Living Allowance/Volunteer Stipends |
ACSN Full-Time Members |
|
|
|
ACSN Half-Time Members |
|
|
|
ACSN Reduced Half-Time Members |
|
|
|
ACSN Quarter-Time Members |
|
|
|
ACSN Minimum-Time Members |
|
|
|
VISTA Full-Time (Federal) Living Allowance |
|
|
|
VISTA Full-Time (non-Federal) Living Allowance |
|
|
|
VISTA Summer Associate (Federal) Living Allowance |
|
|
|
VISTA Summer Associate (non-Federal) Living Allowance |
|
|
|
FGP – CNCS Funded Stipends |
|
|
|
SCP – CNCS Funded Stipends |
|
|
|
FGP – Non-CNCS Funded Stipends |
|
|
|
SCP – Non-CNCS Funded Stipends |
|
|
|
FGP – Non-Stipended Volunteers |
|
|
|
SCP – Non-Stipended Volunteers |
|
|
(Member) End-of-Service Stipends |
End of Service Stipend – VISTA Leader |
|
|
|
End of Service Stipend - VISTA Regular |
|
|
|
End of Service Stipend – VISTA Summer Associate |
|
|
Fringe Benefits |
(Applicant-defined) |
|
|
|
FICA |
|
|
|
Health Coverage |
|
|
|
Worker's Compensation |
|
|
Travel |
(Applicant-defined) |
|
|
Equipment |
(Applicant-defined) |
|
|
Supplies |
(Applicant-defined) |
|
|
Contractual |
(Applicant-defined) |
|
|
|
Member Payroll |
|
|
Training |
(Applicant-defined) |
|
|
Evaluation |
(Applicant-defined) |
|
|
Criminal Background Checks |
(Applicant-defined) |
|
|
Other Costs |
(Applicant-defined) |
|
|
|
Member Relocation |
|
|
|
Accident Insurance |
|
|
|
Liability Insurance |
|
|
|
Excess Auto Insurance |
|
|
|
Meals |
|
|
|
Recognition |
|
|
|
Uniforms |
|
|
|
Physical (Medical) Examinations |
|
|
|
Federal COLA Increase |
|
|
|
Non-Federal COLA/Costshare Increase |
|
IC. Subgrant/Pass-through Costs |
Subgrant/Pass-through Costs |
(Applicant-defined) |
|
ID. Fixed Amount Costs |
Volunteers |
FGP Volunteer Service Years |
|
|
|
SCP Volunteer Service Years |
|
|
Members |
ACSN Full-Time Members |
|
|
|
ACSN Half-Time Members |
|
|
|
ACSN Reduced Half-Time Members |
|
|
|
ACSN Quarter-Time Members |
|
|
|
ACSN Minimum-Time Members |
|
|
Other Fixed Amount Award Basis |
Agency Defined |
Section II – Indirect Costs |
IIA. Negotiated Federal Indirect Cost Rate |
|
|
|
IIB. 10% De Minimis Rate |
|
|
|
IIC. AmeriCorps Program Rate |
|
Commission Fixed Amount |
|
|
|
Corporation Fixed Amount |
|
IID. State Approved Cost Allocation Plan |
|
|
|
IIE. Other Approved Cost Allocation Plan |
|
|
Section III – Sources of non-CNCS Funds |
|
|
|
Source Type Federal Government State Government Local Government Private Program Income Cash on Hand Other |
Source Name or Description |
Classification Cash In-Kind |
Non-CNCS Amount |
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Borgstrom, Amy |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |