AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION

INTERNAL USE ONLY:

Project Title: 

Project Number: 

State: 

Focus Area: 

APD: 

Rural 

APPLICANT INFORMATION

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 Organization 

Federal Government

Tribal Nation

Local Government or Municipality 

National Nonprofit

School

State Government

4 

Authorized 

Representative

Organizational Title

Phone Number Ext.

Email Address

5 

Project Site 

Supervisor

Organizational Title

Phone Number Ext.

Email Address

PROJECT INFORMATION

6 

Estimated 

Completion 

Time (Weeks)

Project Start Date Flexible Fixed

Project End Date Flexible Fixed

Urban Suburban Wilderness

New Sponsor Returning Sponsor

1 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
PROJECT FOCUS AREAS AND OBJECTIVES

7 Primary Area of 

Community 

Need

Energy Conservation

Environmental Stewardship and Conservation 

Infrastructure Improvement

Natural and Other Disasters

Urban and Rural Development

8 

Secondary 

Area of 

Community 

Need

Energy Conservation 

Environmental Stewardship and Conservation

Infrastructure Improvement 

Natural and Other Disasters 

Urban and Rural Development 

Disaster Type 

(if applicable)

Preparedness 

Readiness

Mitigation 

Recovery 

Not Applicable 

9 

Project Objectives

Access to Care

At-Risk Ecosystems

Awareness and Stewardship

Capacity Building and Leverage

Community Support

Energy Efficiency

Support

Disaster Assistance Provided

Education

Financial Literacy

Housing

Alleviate Poverty 

Advance Racial Equity 

Mitigate the Impacts of 

the COVID-19 Pandemic 

and Other Public Health 

Crises 

Reduce Greenhouse 

Gas Emissions 

Conserve Lands and

Waters and Adapt to 

Changing Climate 

Expand Educational and 

Economic Opportunity 

Service to Under-served

Individuals and 

Communities 

Inclusion of People with Disabilities

10

2 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
AREAS SERVED BY THE PROJECT

11

State or Territory City or County

State or Territory City or County

State or Territory City or County

State or Territory City or County

OTHER

12

Organization 

Goals Relevant 

to the Project

1 

2 

3 

13

Are there any required permits or zoning variances for this project? Yes No 

If ‘Yes,’ please list the specific permits or zoning variances required and state whether you have secured 

them. Though not required at the time of application, proof of permits may be requested at a later date.

14

Is your organization currently funded wholly or in part 

by AmeriCorps?

Yes No 

If ‘Yes,’ is the proposed project funded by an AmeriCorps 

State and National grant or any AmeriCorps VISTA resources?

If ‘Yes,’ to either of the above questions, please provide detailed information concerning the 

funding source and utilization of those funds.

15

Will the proposed service replace any of your organization’s 

current or projected staff or contracted labor?

Yes No 

16 Could this project be impacted by inclement weather?

Yes No 

Yes No 

3 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
If ‘Yes,’ do you have sufficient alternate project work

opportunities for at least 25% of the project time for the team

should there be inclement weather? You will need to provide 

your inclement weather plan as part of the Need and 

Project Design Narrative (Question 26). 

17

AmeriCorps conducts background checks on all members

which consists of fingerprint-based FBI criminal history

search and a check of the National Sex Offender Public 

Website (NSOPW.org). Will your organization conduct 

additional background checks? 

Yes No 

If ‘Yes,’ please specify what additional background checks are required and how these 

requirements will be satisfied. If an organization requires additional background checks for

AmeriCorps NCCC members, the organization is responsible for fees associated with the 

background checks and completing background checks prior to or at the start of the project.

18

Does this project include possible exposure of 

AmeriCorps NCCC members to asbestos, lead paint, hazardous 

waste, mold, or any other safety hazards?*

Yes No

19

Will members be required to work with potentially hazardous 

chemicals such as solvents, acids, pesticides, herbicides, 

adhesives, etc.?*

Yes No

Are there any current or recent (within the last five years) 

environmental hazards that campus staff should be aware of 

near the service and/or lodging sites?* Examples could include 

but are not limited to: tap water that is undrinkable or not 

recommended to drink, chemical or hazardous waste spills, 

mine blowouts impacting waterways/groundwater, chemical 

weapon storage locations, or oil spills. 

Yes No 20

Are there any health or environmental conditions that might 

preclude an AmeriCorps NCCC member from fully 

participating based on project location or project conditions?*

Yes No 

*Selection of ‘Yes’ to this question does not preclude your organization from receiving an AmeriCorps NCCC team. You will need to.

further explain any hazards or conditions in the Safety and Security Narrative (Question 31). 

21

4 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
LOCATIONS

22

Location of Service #1 Primary Site? Yes No

Organization

Projected Start Date Projected End Date

Street Address

Address Line 2

County City State ZIP

Accessible for people 

with disabilities? Yes No

Site Supervisor Name

Organizational Title

Email Address Phone Number

Location of Service #2 Primary Site? Yes No

Organization

Projected Start Date Projected End Date

Street Address

Address Line 2

County City State ZIP

Accessible for people 

with disabilities? Yes No

Site Supervisor Name

Organizational Title

Email Address Phone Number

Location of Service #3 Primary Site? Yes No 

Organization

Projected Start Date Projected End Date

Street Address

Address Line 2

County City State ZIP

Accessible for people 

with disabilities? Yes No

Site Supervisor Name

Organizational Title

Email Address Phone Number

*For projects with more than three site locations, please include an attachment with the information

required above for each additional location.

5 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
LODGING SITE #1

23

Lodging Provider

Street Address 

City State Zip 

Anticipated 

Arrival Date

Anticipated 

Departure Date

Type of Lodging

Apartment or Condo Hotel

Armory Military Facility

Bed and Breakfast NCCC Campus

Cabin Recreational Vehicle

Campsite School Room or Classroom Trailer

Church or Other Faith- Summer Camp 

Based Organization

Vacant Home

Community Center

Volunteer Housing

Dorm

Yurt

Short Term Rental

Other

Hostel

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

Accessible for 

people with 

disabilities?

Yes No Beds

provided?

Yes No Number of 

sleeping spaces 

available?

If you’ve selected 

Yes, is it accessible 

for:

Hearing Vision Mobility

Showers on site? Yes No Laundry on 

site? Yes No Wi-Fi 

access 

on site?

Yes No

Full Kitchen(including 

stove and fridge) on 

site?

Yes No If no full 

kitchen, are 

meals 

provided?

Yes No Is there a 

on site? 

Yes

microwave 

No

6 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
24

LODGING SITE #1 Continued

Lodging Contact

Name

Phone number Email Address

Is lodging currently move-in ready? Please explain. If lodging is not currently move-in ready, 

when will it be ready by (include date)?

Please use the space provided below to address the requested information for the Lodging Narrative in

the AmeriCorps NCCC Service Project Application Instructions.

7 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
NARRATIVES

Please refer to the Service Project Application Instructions for requirements for each narrative. 

25 Executive Summary (Include Organizational Capacity) 

8 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
26 Need and Project Design

9 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
27 Project Management and Training

10 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
28 Recruitment

11 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
29 Member Development (Please include skills members will gain and an 

explanation of how those skills will advance member development.)

12 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
30 Strengthening Communities

13 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
31 Safety and Security

14 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
32 Tools and Equipment

15 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
IMPORTANT NOTICES SECTION

REQUIRED ATTACHMENTS: Supporting documentation is a critical component of the Service Project Application. The 

supporting materials requested below will help AmeriCorps NCCC Regional staff develop a better understanding of the 

proposed project during the application review process. Samples and templates are available from AmeriCorps NCCC 

Regional staff.

ON-SITE ORIENTATION: Please attach a comprehensive on-site orientation agenda to your 

application. This should include an overview of your organization and the project, introductions of the 

team to the staff of the sponsoring organization(s), tour of the work site(s) and the community, safety 

and security, and a lodging use overview.

TRAINING PLAN: Please attach a training plan outlining the training that AmeriCorps NCCC members 

will receive during the project. This plan should include tool training, safety training, and project 

specific training (e.g., positive youth development, tree identification, roofing instruction, etc.). If a 

variety of tasks have been proposed in the work plan, the training plan should identify how/when 

members will be trained to perform the task.

PROJECT WORK CALENDAR: Include a project work plan that outlines the schedule of work. The 

schedule will assist in planning where a team will perform work, which staff member will work with the

team, the assigned task(s) for each work day and the number of AmeriCorps NCCC members it will

take to complete each task. The work plan calendar is an essential part of demonstrating how the 

organization will provide at least 40 hours of work for each member of the team.

OPTIONAL ATTACHMENTS: The supporting materials requested below are OPTIONAL and will help AmeriCorps NCCC 

Regional staff develop a better understanding of the proposed project during the application review process.

LODGING PHOTOS: Please provide at least one clearly labeled photo of the proposed team lodging.

Strong 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, trail system map, community housing map, 

etc.), or similar supporting documentation sometimes can help support the high level of detail you 

have provided in the Need Narrative and the Project Design Narrative.

ADDITIONAL 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. This agreement must be signed by both 

parties before a team arrives to the project.

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, site supervisors, 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.

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: AmeriCorps 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 AmeriCorps 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 AmeriCorps 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 AmeriCorps member of

the NCCC program or federal employee will be processed by AmeriCorps and the Department of Labor.

16 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025
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. AmeriCorps 

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 AmeriCorps, 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 AmeriCorps 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

17 OMB Control Number: 3045-0010 

Expiration Date: 10/31/2025