AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)

SERVICE PROJECT APPLICATION 

INTERNAL USE ONLY: 

roject Title: 

roject ID: 

tate: ocus Area: 

PD: 

elect one: ☐Rural ☐Urban ☐ Suburban 

elect one: ☐ New Sponsor ☐ Repeat Sponsor 

P

P

S

F

A

S

S

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 

 

 

Organization Name 

Mailing Address 

City State ZIP 

Office Telephone Ext. 

Secondary Sponsor 

Organization Name 

Mailing Address 

City State ZIP 

Office Telephone Ext. 

EIN Secondary 

Sponsor EIN 

Organization Type 

 Community-Based Nonprofit Organization 

 Federal Government 

 Indian Tribe 

 Local Government or Municipality 

 National Nonprofit 

 School 

 State Government 

Authorized 

Representative 

Organizational Title 

Phone Number Ext. 

Email Address 

Project Site 

Supervisor 

Organizational Title 

Phone Number Ext. 

Email Address 

Estimated 

Completion Time 

(Weeks) 

Project Start Date Fixed or Flexible? 

Project End Date Fixed or Flexible? 

APPLICATION INFORMATION 

PROJECT INFORMATION 

1 

2 

3 

4 

5 

6 
 

 

PROJECT FOCUS AREAS AND OBJECTIVES 

 Energy Conservation 

 Environmental Stewardship and Conservation 

7 Primary Area of 

Community Need 





Infrastructure Improvement 

Natural and Other Disasters 

 Urban and Rural Development 

 Preparedness 

8 Disaster Type 

(if applicable) 





Mitigation 

Readiness 

 Recovery 

 Access to Care 

 At-Risk Ecosystems 

 Awareness and Stewardship 

 Capacity Building and Leverage 

 Community Support 

 Disaster Assistance Provided 

9 

Project Objectives 



Education Support 

Energy Efficiency 

 Engaging Participants 

 Environmental Conservation 

 Financial Literacy 

 Housing 

 Inclusion of People with Disabilities 

Other (please specify) 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC)

SERVICE PROJECT APPLICATION 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

AREAS AFFECTED BY THE PROJECT 

10 

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 

11 

Organization Goals 

Relevant to the 

Project 

1 

2 

3 

12 

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. 

13 

Is your organization currently funded wholly or in part by the Corporation 

for National and Community Service? 





Yes 

No 

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

National grant or any AmeriCorps VISTA resources? 





Yes 

No 

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

and utilization of those funds. 

14 Will the proposed service replace any of your organization’s current or 

projected staff or contracted labor? 





Yes 

No 

 Yes 

15 Could this project be impacted by inclement weather?  No 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

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? 





Yes 

No 

16 

The Corporation for National and Community Service conducts history 

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. 

17 

Does this project include possible exposure of 

AmeriCorps NCCC members to asbestos, lead paint, 

hazardous waste, mold, or any other safety hazards?* 





Yes 

No 

18 

Will members be required to work with potentially 

hazardous chemicals such as solvents, acids, 

pesticides, herbicides, adhesives, etc.?* 





Yes 

No 

19 

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

hazards or

of ‘Yes’ to this question

conditions in the Safety

does not preclude your organization from receiving 

and Security Narrative (Question 30). 

an AmeriCorps NCCC team. You will need to further explain any 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

Continue onto next page 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

LOCATIONS 

Location of Service #1 Primary Site? Yes No 

Organization 

Projected Start Date Projected End Date 

Street Address 

Address Line 2 

City State ZIP 

Accessible for people 

with disabilities? Yes No

Site Supervisor Name 

Organizational Title 

Email Address Phone Number 

20 

Location of Service #2 Primary Site? Yes No 

Organization 

Projected Start Date Projected End Date 

Street Address 

Address Line 2 

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 

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 attach a PDF with the information 

additional site location. 

required above for each

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 

LODGING SITE #1 

21 

Lodging Provider 

Anticipated Arrival 

Date Anticipated Departure Date 

Type of Lodging 





















Apartment or Condo 

Armory 

Bed and Breakfast 

Cabin 

Campsite 

Church or Other Faith-Based 

Organization 

Community Center 

Dorm 

Homestay 

Hostel 





















Hotel 

Military Facility 

NCCC Campus 

Recreational Vehicle 

School Room or Classroom 

Trailer 

Vacant Home 

Volunteering Housing 

Yurt 

Other 

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 

Street Address 

Address Line 2 

City State ZIP 

Accessible for people 

with disabilities? 





Yes 

No 

Beds provided? 





Yes 

No 

Full Kitchen (including 

stove and fridge) on 

site? 





Yes 

No 

If no full kitchen, 

microwave oven 

on site? 





Yes 

No 

Showers on site? 





Yes 

No 

Laundry on site? 





Yes 

No 
 

 

21 

LODGING SITE #1 Continued 

Lodging Contact 

Name 

Phone number Email Address 

Please use the space provided below to further describe team lodging accommodations. 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

NARRATIVES 

Please refer to the application instructions guide for full details on requirements for each section. 

22 Executive Summary 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

23 Need 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

24 Project Design 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

25 Project Management 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

26 Recruitment 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

27 Member Development 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

28 Strengthening Communities 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

29 Organizational Capacity 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

30 Safety and Security 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

31 Tools and Equipment 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL QUESTIONS 

 I am an NCCC alum. 

 I am a past NCCC Sponsor. 

 I am a past NCCC Staff member. 

 From a NCCC alum. 

 From a NCCC Staff member. 

 From a current NCCC member. 

* How did you hear about 

AmeriCorps NCCC? 

 From a state CNCS office. 

 From an AmeriCorps State or VISTA member. 

 From a community partner. 

 By email. 

 On social media (e.g. Facebook, Twitter, Instagram, YouTube, LinkedIn). 

 On the CNCS Website. 

 Other. 

Has your organization previously sponsored an 

AmeriCorps NCCC team? 





Yes 

No 

** 

If ‘Yes,’ how many teams have served with your 

organization? 

If ‘Yes,’ when did a team most recently serve with 

your organization? 

*** 

Has your organization ever had a “Fee-for-Service” 

arrangement with a Youth Corps or Conservation 

Corps program? 





Yes 

No 

If ‘Yes,’ AmeriCorps NCCC has effectively been used in past projects to augment and support existing Youth 

Corps partnerships with organizations. Please describe how you plan to utilize the AmeriCorps NCCC team 

with your existing partnership with the “Fee-for-Service” Corps. 

**** 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

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 provided for your convenience in the appendix of the “Service Project Application Instructions” 

document provided by your region’s campus or online at www.nationalservice.gov/ncccsponsor. Please include the following documentation 

when submitting your application. 

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 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 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. Teams cannot begin work on the project until this 

agreement is approved by signature by both parties. 

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 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: The Corporation for National and Community Service (CNCS) 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 CNCS 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 CNCS 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 NCCC member or federal 

employee will be processed by CNCS and the Department of Labor. 

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, 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022 
AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

SERVICE PROJECT APPLICATION 

color, national origin, sex, age, disability, and in most instances, religion. CNCS 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 CNCS, 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 CNCS 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 

 

 

 

 

 

 

 

 

 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022