1 Ed Award Commitment Matching Form

Approved by OIRA 3045-0143 exp 3/31/2025

Schools of National Service Commitment Form
* indicates required field
School Information
School Name*
Specific Department or School*
Website*
City*
State* (Drop Down)
Contact Information
Email*
Full Name*
Phone*
Fax Number
School Mailing Address
Address
Address 2
City/Town
State/Province (Drop Down)
ZIP/Postal Code

Country (Drop Down)
President, Provost, or Dean who is certifying this commitment form (if different
from contact person)
Full Name
Email
Phone
Fax Number
School Profile
School Type* - Select Private or Public
Program Type
Please choose all that apply.
• 2-year degree (Associate)
• 4-year degree (Bachelor)
• CTE (career and technical education)
• Graduate
• Other (Eligible post-secondary institutions, including many technical schools and
G.I. Bill-approved programs.)
School is eligible to award federal student aid funds based on:
Please choose all that apply.
• Title IV
• VA Qualified
Is your school:
Please choose all that apply.
• Faith-based
• Tribal College
• Historically Black College/University
• Hispanic Serving Institution

Section II: Commitment Level
Detailed Description
Provide a detailed description of what your institution is offering for the Schools of
National Service Program. This language will be posted on our website and should
clearly outline your institution’s commitment to AmeriCorps members and alumni.
Include any benefits that your institution will offer to AmeriCorps members and alumni,
as well as the dollar match for Segal AmeriCorps Education awards, if applicable. For a
list of incentives an institution might provide, please see here.
There are many options for becoming a School of National Service. However,
educational institutions that select to match the Segal Education Award must provide a
minimum match of $1,000 to be listed on the AmeriCorps website as a Schools of
National Service matching institution. A dollar for dollar match is the preferred level of
commitment from schools that participate in this program benefit.
Provide Description*

Our institution's commitment includes programs offered (check all that apply):
•

Online

•

In person

Commitment to Seniors
Please indicate below if your school offers benefits to senior citizens (I.e., free classes,
reduced tuition, etc.) and at what age eligibility begins.

Section III: Commitment Timeframe
This commitment to AmeriCorps is valid from the date of signature on this agreement
until terminated or modified by the institution.

If the institution needs to terminate this agreement, AmeriCorps must be notified to in
order to delete the website listing; otherwise students will continue to contact the
institution. AmeriCorps reserves the right to delete the website listing for any institution
not in compliance with the Schools of National Service Program requirements.
Signature*
Date*
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