Appendix C.1 - Sample AmeriCorps Seniors FGP-SCP Memorandum of Understanding

# Appendix C.1 – Sample AmeriCorps Seniors FGP/SCP Memorandum of Understanding

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**Memorandum of Understanding**

ABC County Foster Grandparent/Senior Companion Program

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This Memorandum of Understanding (this “**MOU**”) contains basic provisions, which will guide the working relationship between both parties.  It is entered into by and between **ABC County FGP/SCP**, sponsored by **ABC SPONSOR AGENCY** and the following agency and/or entity (the “**Station**”):

**Station Name: 						                                          EIN:**________________****

**Station Site Address:  City:  State:  Zip:**

**Station email: 				   	                                            Phone:**

The *ABC County* and the *Station* may be referred to herein as the “**Parties**.”

This MOU is effective from  through. This MOU may be amended in writing at any time with the concurrence of both parties and must be renegotiated at least every three (3) years*.*****

**Basic Provisions**

**The ABC County’s Responsibilities**

1. Recruit, interview, select, and enroll volunteers in the program. The volunteers will meet the criteria in the AmeriCorps Seniors Foster Grandparent Program (FGP) or the AmeriCorps Seniors Senior Companion Program (SCP) Federal Regulations for enrollment in the program.

2. Unless otherwise specified herein, conduct and document a criminal history check for all AmeriCorps Seniors volunteers in the FGP/SCP program in accordance with the requirements established for a National Service Criminal History Check by the AmeriCorps.

3. Refer AmeriCorps Seniors volunteers in FGP/SCP to the Station. Permit and encourage the Volunteer Station to screen AmeriCorps Seniors volunteers pursuant to established criteria of Volunteer Station.

4. (*If Applicable*) Arrange for pre-service physical examinations for new AmeriCorps Seniors volunteers assigned to the Volunteer Station.

5. Conduct pre-service orientation and ongoing in-service instruction for volunteers.

6. Instruct AmeriCorps Seniors volunteers in proper use of volunteer timesheets, reimbursement guidance, and the AmeriCorps Seniors FGP/SCP procedures.

7. Provide an AmeriCorps Seniors volunteers in FGP/SCP orientation to the Station staff prior to placement of volunteers and at other times as needed.

8. Initiate publicity regarding AmeriCorps Seniors FGP/SCP.

9. Furnish accident, liability, and excess automobile liability insurance for enrolled volunteers as required by AmeriCorps Seniors FGP/SCP regulation. The insurance provided by the sponsor is secondary coverage and is not primary insurance.

10. Staff an Advisory Council to AmeriCorps Seniors FGP/SCP. Along with the advisory council, arrange for appeals procedure to address problems arising between the volunteer, the Station and/or AmeriCorps Seniors FGP/SCP. 

11. Arrange for appropriate AmeriCorps Seniors FGP/SCP recognition.

12. Coordinate with other volunteer and aging programs in the area to foster effective communication and avoid duplication. 

13. Reimburse AmeriCorps Seniors volunteers for transportation costs between their home and volunteer station in accordance with AmeriCorps Seniors FGP/SCP policies and availability of funds.

14. Arrange with the Station for meals and/or snacks, whenever possible, for volunteers on assignment. 

15. *(if applicable)* Provide photo identification for volunteers if not provided by the station. 

**The Station’s Responsibilities**

1. (**AmeriCorps Seniors FGP only**) In partnership with the project staff, the station staff will develop an assignment plan for each AmeriCorps Seniors volunteers in FGP and for each child served. The sponsor's representative, and the volunteer must sign the written assignment plan that: identifies the children to be served; the role and activities of the volunteer; the expected outcomes for each child; and addresses the period of time each child should receive such services.  Volunteer station staff, AmeriCorps Seniors FGP project staff, and the volunteer will review the AmeriCorps Seniors volunteer's assignment as well as the impact of the assignment on the child's development.

2. (**AmeriCorps Seniors FGP only**) Assign children with designated special or exceptional needs to each volunteer.

3. (**AmeriCorps Seniors FGP only**) Exclude Foster Grandparents as supervising adults when calculating state-mandated adult-to-child ratios.  

4. (**AmeriCorps Seniors FGP only**) Supervise Foster Grandparents at all times while they are performing as volunteers and not leave the Foster Grandparent alone with children. (Supervisor name and contact information on next page.)

5. (**AmeriCorps Seniors SCP only**) In partnership with the project staff, the station staff will develop an assignment plan for each AmeriCorps Seniors volunteer in SCP and for each client served. The sponsor's representative, and the volunteer must sign the written assignment plan that: identifies the clients to be served; the role and activities of the volunteer; the expected outcomes for each client; and addresses the period of time each client should receive such services.  Volunteer station staff, AmeriCorps Seniors SCP project staff, and the volunteer will review the AmeriCorps Seniors volunteer’s assignment as well as the impact on the client’s ability to continue to live independent in their home, or the impact of respite for caregiver. 

6. (**AmeriCorps Seniors SCP only**) Assign adults with special needs to each volunteer.

7. Provide site specific and special training (i.e. confidentiality training) to the volunteers as needed.

8. Furnish volunteers with materials required for assignment.  These materials may include station uniform and photo I.D.

9. Assure adequate health and safety provisions for volunteers.

10. Investigate and report any accidents and injuries involving AmeriCorps Seniors volunteers immediately to ABC County.  All reports shall be submitted in writing.

11. Specify, either by written information or verbally, that AmeriCorps Seniors volunteers are participants in the Station’s programming in publicity featuring such volunteers.  Display an AmeriCorps Seniors placard where it may be viewed by the public.

12. **Reports:** The Station Representative shall:

· Timesheets**:** Report volunteer hours on a monthly basis on or before 10th of the following month (Insurance coverage is only effective with verified records of hours served.)

· Progress Reports: Stations are requested to complete a short bi-annual survey provided by AmeriCorps Seniors FGP/SCP documenting the impacts of services provided by volunteers. 

· Volunteer Performance Evaluations:  For each assigned volunteer, stations are required to complete an annual performance evaluation using the template provided by the sponsor.

· In-Kind Documentation: Provide documentation of in-kind contribution(s) (meals, uniforms, mileage reimbursement, training expenses, physical exams) and verification to help AmeriCorps Seniors FGP/SCP meet its local match of 10%. 

11. *(if applicable)* Arrange for annual physical examinations for up to  AmeriCorps Seniors volunteers (including a 20% turnover rate) at $ per examination.  Donor verifies funds are not from other federal sources unless authorized under law. For these volunteers, the Volunteer Station will obtain, and provide the sponsor with a certificate signed by the examining medical professional confirming that the volunteer is capable, with or without reasonable accommodation, to either himself/herself or the children/clients served.  

12. *(if applicable)* Provide meals for up to #  volunteers each day and provide a regular accounting to the AmeriCorps Seniors FGP/SCP of the value of meals provided.  Since the value of these meals will be counted as part of the non-federal contribution to the AmeriCorps Seniors  grant, the Volunteer Station will ensure that the meals provided and reported to the AmeriCorps Seniors FGP/SCP are not funded with other federal resources, unless those federal resources are authorized by federal law or regulation to be applied as part of the non-federal share of a federal grant.      

13. *(if applicable)* Provide transportation for up to # volunteers each day and provide a regular accounting to the AmeriCorps Seniors FGP/SCP of the value of the transportation provided.  Since the value of this transportation will be counted as part of the non-federal contribution to the AmeriCorps Seniors grant, the Volunteer Station will ensure that the transportation provided and reported to the AmeriCorps Seniors FGP/SCP is not funded with other federal resources, unless those federal resources are authorized by federal law or regulation to be applied as part of the non-federal share of a federal grant.      

**Other Provisions**

1. **Separation from Volunteer Service**:  The Station may request the removal of an AmeriCorps Seniors volunteer at any time.  An AmeriCorps Seniors volunteer may withdraw from service at the Station or from the AmeriCorps Seniors FGP/SCP at any time. The AmeriCorps Seniors FGP/SCP staff, the Station staff, and volunteers are encouraged to communicate to resolve concerns or conflicts, or take remedial action, including, but not limited to, placement with another station.

2. **AmeriCorps Seniors FGP Letters of Agreement:**  For in-home assignments, the Volunteer Station will obtain a Letter of Agreement signed by the person or persons legally responsible for the child served, the Volunteer Station liaison, and the AmeriCorps Seniors FGP liaison authorizing the assignment of a AmeriCorps Seniors volunteer in FGP in the child’s home, defining the AmeriCorps Seniors volunteer activities, and specifying supervisory arrangements.  

3. **AmeriCorps Seniors SCP Letters of Agreement:**  For in-home assignments, the Volunteer Station will obtain a Letter of Agreement signed by the client, or persons legally responsible for the client served, the Volunteer Station liaison, and the AmeriCorps Seniors SCP liaison authorizing the assignment of a AmeriCorps Seniors volunteer in SCP in the client’s home, defining AmeriCorps Seniors volunteer’s activities, and specifying supervisory arrangements.  

4. **Religious/Political Activities**:  The Station will not request or assign AmeriCorps Seniors volunteers to conduct or engage in religious, sectarian, or political activities.

5. **Displacement of Employees:**  Ensure that AmeriCorps Seniors volunteers serve in a volunteer capacity.  AmeriCorps Seniors volunteers will not displace nor replace paid or contracted employees, relieve staff of their routine duties or infringe upon the site supervisor's supervisory role with the children (or AmeriCorps Seniors SCP client). 

6. **Compensation:**  Neither the station nor AmeriCorps Seniors FGP/SCP will request or receive compensation from the beneficiaries of AmeriCorps Seniors volunteers.  AmeriCorps Seniors volunteers will not receive a fee for service from beneficiaries. 

7. **Accessibility and Reasonable Accommodation**: The Station will maintain the programs and activities to which AmeriCorps Seniors volunteers are assigned accessible to persons with disabilities (including mobility, hearing, vision, mental, and cognitive impairments or addictions and diseases) and/or limited English language proficiency and provide reasonable accommodation to allow persons with disabilities to participate in programs and activities.

8. **Prohibition of Discrimination:**  The Station will not discriminate against AmeriCorps Seniors volunteers, service beneficiaries, or in the operation of its program on the basis of race, color, national origin including individuals with limited English proficiency, gender, age, religion, sexual orientation, disability, gender identity or expression, political affiliation, marital or parental status, or military service. 

9. **Termination of MOU**: This MOU may be terminated at any time by either party by sending written notice of termination of the MOU to the other party.  This MOU shall be reviewed at least every three (3) years by the Parties.

10. **Signatures**.  By signing this MOU, the Station, through its authorized representative, self-certifies that it meets the requirements necessary to become an AmeriCorps Seniors FGP/SCP Station.

**For All Stations**

***Volunteer Supervisor [Station Staff]***

Volunteer Station Primary Type:****To qualify as an AmeriCorps Seniors FGP/SCP Station, an agency/office/department must self-certify that it is one of the following:

|_|Public Non-Profit   |_|Private Non-Profit   |_|Proprietary Health Care Agency   |_|Governmental Agency 

**Authorized Signatures**

**_____________________________________________________________________________________**

**Authorized Station Representative 						Date**

**_____________________________________________________________________________________**

**Project Director [or other sponsor designated representative]		Date**

Version 2020.2		Pg. 2 of 4This document is provided as a sample ONLY. Its use is optional and, if used, it should be customized as appropriate. For all appendices, including editable versions of samples and templates, visit https://www.nationalservice.gov/operations-handbook-appendices.

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