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Request for AmeriCorps VISTA Close of Service Travel Assistance Form
AmeriCorps VISTA requires VISTA members to submit this form to obtain financial assistance for close of
service travel assistance. Members must complete and submit this form to VMSUForms@cns.gov
before
the end of their service term.
The reimbursement for close of service travel assistance is financial assistance intended to help offset
the costs associated with traveling to your home at the end of your VISTA service. The Close of Service
Travel Allowance is based on the direct mileage between your physical address immediately prior to
relocation and your VISTA project site. This close of service allowance will be the same amount that you
received at the start of your service term.
VISTA members are eligible for close of service travel assistance if they:
1. Relocated more than 50 miles to report to their project site;
2. Received a Relocation Allowance; AND
3. Are relocating more than 50 miles from the physical address of the project site at the conclusion
of their service term.
If you are eligible, and relocating at the conclusion of your service, please complete, sign this form and
return it to VMSUForms@cns.gov
, and provide a copy to your project sponsor.
By completing and signing this form, you are certifying that you are relocating more than 50 miles at the
conclusion of your service term.
AmeriCorps VISTA will begin processing your close of service travel assistance request upon receipt of
your completed form.
CERTIFICATIONS
By typing your name in the signature block, you are certifying that you are relocating at the conclusion of
your service with AmeriCorps VISTA and that you understand that if you do not relocate that AmeriCorps
may seek to recoup relocation assistance funds from you.
I, ________________________, hereby certify that I have relocated for service with AmeriCorps VISTA,
and will be relocating at the end of my service term as well. I understand that AmeriCorps may seek to
recoup relocation assistance funds from me if I do not relocate.
Signature: Date:
