AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

INTERNAL USE ONLY: 

 

 

 

 

Project Title: 

Project ID: 

State: 

Focus Area: 

APD: 

Select one: ☐Rural ☐Urban ☐ Suburban Wilderness

Select one: ☐ New Sponsor ☐ Repeat Sponsor 

 

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 

PROJECT INFORMATION

5 Project Start Date Project End Date 

AREAS AFFECTED BY THE PROJECT 

6 

State or Territory City or County 

State or Territory City or County 

State or Territory City or County 

LOCATION OF SERVICE 

7 

Organization 

Primary Site ☐ Yes ☐ No Accessible for people 

with disabilities? ☒ Yes ☐ No

Street Address 

Address Line 2 

City State ZIP 

Site Supervisor 

Name

Organizational Title 

Email Address Phone

Number

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022

APPLICATION INFORMATION

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

 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022

LODGING SITE

8 

Lodging Provider 

Anticipated

Arrival Date

Anticipated 

Departure Date 

Type of Lodging 

Apartment or Condo 

Bed and Breakfast 

Cabin 

Campsite 

Church or Other FaithBased Organization 

Community Center 

Dorm 

Short Term Rental

Hostel 

Hotel 

Military Facility 

NCCC Campus 

Recreational Vehicle 

School Room or 

Classroom Trailer

Lodging Category 

Community or FaithBased 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? 

 

Beds provided? 

 

 

 

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

Summer Camp

Vacant Home

Volunteer Housing

Yurt

Other

Number or 

sleeping 

spaces 

available?

If you've selected 

Yes, it is accessible 

for:

Showers on site?

Hearing Vision Mobility

Yes No Laundry on site? Yes No

W-Fi

access

on site?

Yes No

Full kitchen (including 

stove and fridge) on 

site?

Microwave 

on site?

If no full kitchen, 

are meals 

provided?

Yes No Yes No Yes No

Yes No Yes No
 

 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022

NARRATIVES

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

9 Need and Project Design
 

 

 

 

10 Project Management and Training

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022
 

 

 

 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022

11 Safety and Security 
12 Tools and Equipment 

AMERICORPS NATIONAL CIVILIAN COMMUNITY CORPS (NCCC) 

DISASTER RESPONSE PROJECT APPLICATION 

OMB Control Number: 3045-0010 

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

DISASTER RESPONSE PROJECT APPLICATION 

IMPORTANT NOTICES SECTION 

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 the AmeriCorps NCCC program. 

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 

the AmeriCorps NCCC program 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 program's Project Completion Report, and return it to the 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 survey designed to provide the AmeriCorps NCCC program with feedback that will inform continuous 

improvement of services.

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

NCCC Regional staff develop a better understanding of the project. 

LODGING PHOTOS: Please provide at least one clearly labeled photo of the proposed team lodging. 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, community housing map, etc.), or similar supporting documentation. 

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 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 NCCC member or federal 

employee will be processed by AmeriCorps 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, 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 

OMB Control Number: 3045-0010 

Expiration Date: 10/31/2022