Fillable form for multi-state applicants (National Directs) applying for (Maine Commission for Community Service)

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form for multi-state applicants (National Directs) applying for (Maine Commission for Community Service)

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America's Service Commissions is pleased to support the national service field by providing one
form for multi-state applicants (National Directs) applying for an AmeriCorps grant to initiate their
consultation with participating state service commissions.
Why Consultation?
As part of the Serve America Act, National Direct Consultation was established to help increase
collaboration and coordination among national service programs, which in turn supports the
efficient use of national service funds in each state.
Consultation is a requirement outlined in the FY19 AmeriCorps NOFO for new, recompete and
continuation applicants.
State service commissions use the information provided through the National Direct Consultation
process to provide input to the Corporation for National and Community Service (CNCS) on funding
decisions that may impact their state, as well as provide feedback/recommendations to the National
Direct applicant. CNCS asks each commission to provide their input on each National Direct
applicant proposing to place members in the state by selecting “support,” “neutral,” or “do not
support,” along with any comments associated with the opinion submitted.
DEADLINE
This form and the accompanying requested documents are due in advance of the FY19 AmeriCorps
NOFO application deadline established by the Corporation for National and Community Service.
Consultation requirements may vary by state. Consultation is not completed unless you meet all
the requirements by an individual state service commission. Upon completing this form, you may
be contacted for additional information. When possible, it is encouraged that applicants initiate
consultation with state service commissions as soon as possible.
Instructions for completing National Direct Consultation Form:
Please fill out all sections to the best of your ability.
In the provided section, select the states/territories you are planning to request/place members in
your AmeriCorps National application. By submitting this form you are initiating the consultation
process as outlined in the FY19 AmeriCorps State/National NOFO for all states/territories with the
exception of Guam, Hawaii, Missouri, New Jersey, New Mexico, Puerto Rico, and Tennessee.
Contact these commissions directly for instructions on initiating and completing consultation. For
all other states, you only need to submit this form once to initiate consultation.
The state service commissions in the states/territories you selected will review the information you
provided and may reach out with follow up questions or additional requirements to complete
consultation. Please be responsive to any questions, as they will use the information provided in
this form, along with additional information requested, to complete their required feedback to the
Instructions
FY19 National Direct Consultation
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CNCS regarding your application.
Form Completion
Upon successful completion of this form you will see "Thank you for initiating consultation for the
selected state service commissions."
You should receive an email acknowledging receipt from the state service commission(s)
you selected to initiate consultation in the coming weeks.
Attention New or Expanding Programs
It is strongly encouraged that multi-state applicants (national directs) contact the state service
commission(s) as early as possible in ord
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FY19 National Direct Consultation
Please complete each section to the best of your ability.
First and Last Name
Contact's Job Title:
Address
City/Town
State/Territory
ZIP/Postal Code
Email Address
Phone Number
1. Contact information for any follow up questions regarding information submitted in this form:*
Legal Applicant Name
(as listed in CNCS grant
system)
AmeriCorps Program
Name
Grant Application ID #
(as provided in the
CNCS grant system)
2. Program Identification Information:*
3. Please select the state service commission(s) you are completing this consultation form for (all the
states/territories you plan to place members in as part of your FY18 application). If a state is not listed, you
will need to complete their consultation process separately, as listed in the survey instructions.
Consultation is not required in South Dakota, American Samoa and Virgin Islands where there are no state
service commissions.
Alabama
Alaska
Arizona
Arkansas
3
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Mississippi
Montana
Nebraska
New Hampshire
Nevada
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
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Rhode Island
South Carolina
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
4. Provide the executive summary for your program (as instructed for your FY19 AmeriCorps NOFO
application):
Start Date:
End Date:
5. Estimated Program Start and End Dates (i.e.; September 2019 and May 2020)
Year of continuation grant, if applicable:
6. Type of Application for FY19:
New Application
Recompete
Continuation (indicate whether applying for the second or third year)
5
7. CNCS Focus Area(s)
Indicate all CNCS focus areas to be addressed by members serving in state:
Disaster Services
Economic Opportunity
Education
Environmental Stewardship
Healthy Futures
Veterans and Military Families
Capacity Building
Other (please specify)
No file chosen
8. Please upload your AmeriCorps program Performance Measure(s), as you plan to submit them to
CNCS in your FY19 AmeriCorps application.
If you have not finalized your performance measure selection, please provide as much detail you have.
If finalized, you can copy/paste the performance measures as you plan to submit for your CNCS
application.
Choose File
No file chosen
9. Please upload your AmeriCorps program logic model, as you plan to submit to CNCS in your FY19
AmeriCorps application.
If you have not finalized your logic model you may skip this question.
Choose File
10. Describe your AmeriCorps member(s) intervention(s)/activity(ies)? Please share any significant
AmeriCorps member interventions/activities that are included in your grant but not represented within the
performance measures.
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No file chosen
11. Please upload a document organized by state including the following information per expected service
site:
city
county
state
number of MSY requested
local national program staff name(s) and email(s) (if available)
partner service site organization name, contact name, email (if available)
Choose File
No file chosen
12. If your program is an operating AmeriCorps program this program year (2018-2019), please upload a
copy of your current program year service site location report.
Choose File
13. AmeriCorps Program Model (check one):
Nationally-Managed (members at local organizations directly controlled by parent organization)
Affiliate-Managed (members at affiliates of parent – limited direct control)
Consortium (members at independent organizations that interact on activities beyond AmeriCorps)
Intermediary (members at unrelated organizations)
Other (please specify)
14. Describe the roles of the legal applicant and site partners in administration of the program at the state
level:
(i.e. site monitoring; background checks; training and development, member supervision, etc.)
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Expectations
FY19 National Direct Consultation
If you are receive a grant award as part of the FY19 AmeriCOrps NOFO, please contact each state service commission notifying them
of your selection and site placement plans.
Successful National Direct applicants are expected to partner with their state service commissions in the following ways:
Provide up-to-date contact information for program and service site staff
Participate in state service commissions hosted events/trainings
Keep state service commission informed of any changes in your program, add to distribution lists and invite to state
events/trainings
Participate in state service commission needs assessment, training plan and state service plan development.
By providing updated contact information, multi-state applicants can expect state service commissions to:
Invite your program/service site staff and members to applicable trainings/events
Invite participation in statewide needs assessment, training plan and state service plan
Receive periodic updates/information from the state service commission
With any questions related to the consultation process please contact statecommissions@gmail.com.
Please select "Done" to complete submission of your consultation form for the state(s) selected.
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form for multi-state applicants (National Directs) applying for (Maine Commission for Community Service)

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Completed 20 July 2020

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