AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
INTERNAL USE ONLY:
Project Title:
Project ID:
State:
Focus Area:
APD:
Select one: Rural Urban Suburban
Select one: New Sponsor
Repeat Sponsor
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
Local Government or Municipality
Organization
National Nonprofit
Federal Government
School
Indian Tribe
State Government
4
Authorized
Representative
Organizational Title
Phone Number Ext.
Email Address
PROJECT INFORMATION
5 Project Start Date
Project End Date
AREAS AFFECTED BY THE PROJECT
6
State or Territory City or County
State or Territory City or County
State or Territory City or County
LOCATION OF SERVICE
7
Organization
Primary Site
Yes No
Accessible for people
with disabilities?
Yes No
Street Address
Address Line 2
City State ZIP
Site Supervisor
Name
Organizational Title
Email Address
Phone
Number
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
APPLICATION INFORMATION
Please refer to the application instructions for full details on requirements for each section.
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expira
tion Date: 10/31/2022
LODGING SITE
8
Lodging Provider
Anticipated
Arrival Date
Type of Lodging
Apartment or Condo
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
Volunteer 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 (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.
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
NARRATIVES
Please refer to the application instructions for full details on requirements for each section.
9
Need
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
10
Project Design
11
Project Management
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
12
Safety and Security
Tools and Equipment
13
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)
SERVICE PROJECT APPLICATION
IMPORTANT NOTICES SECTION
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.
OPTIONAL ATTACHMENTS: The supporting materials requested below are OPTIONAL and will help AmeriCorps NCCC Regional staff develop
a better understanding of the project.
LODGING PHOTOS: Please provide at least one clearly labeled photo of the proposed team lodging. 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, community housing map, etc.), or similar supporting documentation.
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
OMB Control Number: 3045-0010
Expiration Date: 10/31/2022
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