Segal AmeriCorps Education Award 

Matching Program

Commitment Form

Section I: Profile Information

Name of Higher Education Institution: _____________________________________

If the Ed Award Matching Program applies to a specific department or school, please list here:

______________________________________________________________________

Website: _____________________

City, State: ___________________________________________________________

Primary Contact:

Name: _____________________

Phone: ______________________

Fax: ________________________ 

E-mail: ______________________

Mailing Address: ______________________

President, Provost, or Dean that is signing Commitment Form:

Name: _____________________

Phone: ______________________

Fax: ________________________ 

E-mail: ______________________

Institution Profile:

Type (please check one): 

Public ____ Private _____

Program Types (check all that apply):

2 Year ___ 4 Year ___ Graduate ____

Is Your Institution Eligible to Award Federal Student Aid Funds Based on (check all that 

apply):

Title IV___ VA Qualified ____
Is Your Institution (check all that apply):

Faith-Based ______ Historically Black College/University _____

Tribal College _____ Hispanic Serving Institution ______

Section II: Commitment Level

Provide a detailed description of what your institution is offering for the Segal 

AmeriCorps Education Award Matching Program. This language will be posted on our 

website and should clearly outline your institution’s commitment to AmeriCorps alumni. Include 

the amount of the dollar match along with any additional benefits that your institution will offer to 

AmeriCorps alumni.

Pease note: Educational institutions must provide a minimum match of $1,000 to be 

listed on the CNCS website. A dollar for dollar match is the preferred level of 

commitment from schools that participate in this program

Percentage of the award that your institution will match for an admitted AmeriCorps 

alumni: ________%.

Refer to FAQs for an explanation and current amount of the Segal AmeriCorps Education 

Award. (link to FAQs sheet). The Segal AmeriCorps Education Award is tied to the maximum 

amount of the U.S. Department of Education’s Pell Grant. 

To qualify for this competition, AmeriCorps alumni must have successfully completed their full 

term of service. *Refer to FAQs for a listing of programs and required hours.

*VISTA Summer Associates and AmeriCorps alumni who did not complete service and did not 

terminate for compelling reasons are not eligible for this program. 

Section III: Commitment Timeframe

This commitment to the Corporation for National and Community Service is valid for five (5) 

years from the date of signature on this agreement. This agreement will be up for renewel on 

_________, 2017.

If the institution needs to terminate this agreement, CNCS will be notified to in order to 

delete the website listing; otherwise students will continue to contact the institution.

CNCS reserves the right to delete the website listing for any institution not in compliance with

the Ed Award Matching Program requirements.

Please return this form to: INSERT EMAIL ADDRESS

OR

Fax: 202.606.3475

Ph: TBD